Abstract
Although solid organ transplantation remains the definitive management for patients with end-stage organ failure, this ultimate treatment has been limited by the number of acceptable donor organs. Therefore, efforts have been made to expand the donor pool by utilizing marginal organs from donation after circulatory death or extended criteria donors. However, marginal organs are susceptible to ischemia-reperfusion injury (IRI) and entail higher requirements for organ preservation. Recently, machine perfusion has emerged as a novel preservation strategy for marginal grafts. This technique continually perfuses the organs to mimic the physiologic condition, allows the evaluation of pretransplant graft function, and more excitingly facilitates organ reconditioning during perfusion with pharmacological, gene, and stem cell therapy. As mesenchymal stem cells (MSCs) have anti-oxidative, immunomodulatory, and regenerative properties, mounting studies have demonstrated the therapeutic effects of MSCs on organ IRI and solid organ transplantation. Therefore, MSCs are promising candidates for organ reconditioning during machine perfusion. This review provides an overview of the application of MSCs combined with machine perfusion for lung, kidney, liver, and heart preservation and reconditioning. Promising preclinical results highlight the potential clinical translation of this innovative strategy to improve the quality of marginal grafts.
Highlights
Organ transplantation provides a life-saving opportunity for patients with end-stage organ failure
We presented an overview of the current literature regarding the application of mesenchymal stem cells (MSCs) during machine perfusion on solid organ transplantation
Nakajima et al suggested that hepatocyte growth factor (HGF) probably mediated the amelioration of pulmonary edema and lung injury after transplantation in the group treated with MSCs and normothermic machine perfusion (NMP), since its concentration was high in both perfusate and lung tissue
Summary
Organ transplantation provides a life-saving opportunity for patients with end-stage organ failure. In the process of organ transplantation, the donor grafts will be deprived of blood supply during procurement and suffer from a long duration of ischemia when the grafts are preserved and transported. Machine perfusion is proposed to reduce the IRI with an improvement of graft quality and prolong organ preservation time, as well as allow objective evaluation for the viability of grafts during preservation [10]. Another highlight of machine perfusion is offering a pivotal opportunity to recondition the high-risk grafts during preservation [11]. We presented an overview of the current literature regarding the application of MSCs during machine perfusion on solid organ transplantation
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