An observational study in Liver Transplantation, sponsored by Papa Giovanni XXIII Hospital. Status unknown at 1 site in Italy. Open to participants aged 30 Days to 70 Years. Per ClinicalTrials.gov, last updated 2019-11-26.
Sponsored by Papa Giovanni XXIII Hospital · Observational
In light of the widespread organ shortage, dynamic preservation by means of Machine Perfusion (MP) has been proposed as a strategy to increase the pool of suitable grafts for liver transplantation. Reproducing more physiological conditions than traditional Static Cold Storage (SCS), MP may allow a better preservation and evaluation and perhaps even the resuscitation of high risk grafts. As a consequence, unnecessary discard of organs could be avoided and quality and safety of transplantation could be improved as well.
Hypothermic MP (HMP) seems to reduce ischemia-reperfusion injury. In fact, hypothermia slows down the metabolic rate and the oxygenation of the perfusate leads to re-synthesis of Adenosine TriPhosphate (ATP), which results in the restoration of cellular energy.
Four series about the use of HMP in the clinical setting has been published so far. They all report acceptable outcomes after transplantation of human liver grafts from extended criteria Brain Dead Donors (BDD) and from Donation after Circulatory Death (DCD) donors preserved by HMP, thus proving its feasibility and safety. The efficacy of HMP, instead, is still under investigation in a phase II randomized trial.
This is an observational, prospective, monocentric study aiming at verifying the feasibility and safety of post-SCS Hypothermic Oxygenated PErfusion (HOPE) in the setting of our liver transplant program. Extended criteria grafts from BDD and grafts from DCD donors will be preserved by post-SCS HOPE prior to transplantation. The recipients of these grafts will be followed-up for at least 1 year.
This is an observational, prospective, monocentric study aiming at verifying the feasibility and safety of post-SCS HOPE in the setting of our liver transplant program.
20 consecutive patients with written informed consent will be enrolled. They will be transplanted with grafts from extended criteria BDD or from DCD donors preserved by post-SCS HOPE.
The HOPE procedure will be performed in our operating room after regular procurement, transport and back-table preparation. University of Wisconsin Machine Perfusion Solution (UW-MPS) will be used. Two pumps will provide dual pressure-controlled perfusion through the portal vein and the hepatic artery. Portal flow will be continuous and will be adjusted to keep portal pressure below 5 mmHg. Instead, arterial flow will be pulsatile and will be regulated to maintain arterial pressure between 25 mmHg and 30 mmHg. The perfusate will be oxygenated with the goal of a partial Pressure of Oxygen (PO2) of 50-70 kilopascal. The perfusate temperature will be kept between 4°C and 12°C by a heat exchanger. pH, PO2 and partial Pressure of Carbon Dioxide (PCO2) of the perfusate pumped to the graft and drained from the vena cava will be monitored. HOPE will be maintained for 3 to 4 hours.
Patients will be followed-up for at least 1 year according to a scheduled timetable.
Data about HOPE and transplant procedure, about donors and recipients' characteristics and about patients' follow-up will be collected in a dedicated electronic Case Report Form (eCRF) according to Good Clinical Practice.
498 studies on the registry are indexed under Hypothermia; 53 are open to participants now.
This study's planned enrollment of 20 is below the median of 97 across 126 observational studies indexed under Hypothermia.
Browse Hypothermia studies →Papa Giovanni XXIII Hospital is the lead sponsor of 19 studies on the registry; 6 are open to participants now.
Counted across the registry records on this site, refreshed daily.
All the patients on the waiting list for liver transplantation at Bergamo transplant centre, except for those who are candidates to combined en bloc liver and pancreas transplantation
Grafts inclusion criteria:
Grafts exclusion criteria: living donors.
Recipients' inclusion criteria:
Recipients' exclusion criteria:
Incidence of early allograft dysfunction (safety endpoint)
Occurrence of one or more of the following: bilirubin \>170 µmol/L on Post-Operative Day (POD) 7, International Normalized Ratio (INR) \>1,6 on POD 7, Alanine AminoTransferase (ALT) peak \>2000 U/L within the first post-operative week
Time frame: Post-operative day 7
Rate of complications grade ≥IIIa
Dindo-Clavien classification of surgical complications
Time frame: 1 year after transplantation
Incidence of ischemic cholangiopathy
Radiological or endoscopic diagnosis of unifocal or multifocal intrahepatic strictures in the absence of any arterial complication
Time frame: 6 months after transplantation
Length of intensive care unit and hospital stay
Length of intensive care unit and hospital stay after transplantation (days)
Time frame: 1 year after transplantation
30-day patient survival
Patient survival rate 30 days after transplantation
Time frame: Post-operative day 30
30-day graft survival
Graft survival rate 30 days after transplantation
Time frame: Post-operative day 30
1-year patient survival
Patient survival rate 1 year after transplantation
Time frame: 1 year after transplantation
1-year graft survival
Graft survival rate 1 year after transplantation
Time frame: 1 year after transplantation
Plan to share: No
No publications or documents are linked to this record.
This study is status unknown, as verified in Nov 2019. You cannot join it, but the record below documents what was studied.
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Papa Giovanni XXIII Hospital