In view of the increasing scarcity of suitable organs available for transplantation, it has been necessary to broaden the selection criteria for organs, taking into account also those considered marginal‘ those obtained also from older donors, ‘steady heart (DCD) donors or those with co-morbidity, usually discarded as damaged by complex biological reactions.
However, many of the above organs could be transplanted if the quality and viability of the organ once removed is guaranteed. Therefore, restoring and maintaining the vitality of organs with a post-harvest organ preservation technique is a essential prerequisite for the correct use of even marginal organs, in order to increase their suitability.
The objective is to ensure the maintenance of the vitality of the organ and its function, even if there is no adequate blood supply, an appropriate removal of waste products of metabolism and physiological environment, more in general terms.
In addition, these organs are aggravated by ischaemia and reperfusion damage (ischemia-Reperfusion injury, IRI), which remains an important risk factor for marginal‘organs, limit the success of the transplant and the survival of the organ and/or the recipient, both in the immediate post-surgery and in the long term.
In particular, ischemia represents a lack of blood supply which results in a deficiency of oxygen and glucose, metabolites necessary for cell and tissue survival.
At the cellular level, ischemia leads to anaerobic metabolism and mechanisms are activated that ultimately lead to cell death. At a more macroscopic level, the molecules released by the damaged cells propagate and stimulate an inflammatory response in the tissues. If ischemia persists, the cells and structures continue to deteriorate and there is irreversible ischemic damage.
Resumption of blood flow to the ischemic tissue is called“reperfusion”. Through reperfusion, oxygen and glucose are returned to the tissue and cells. Apoptotic and necrotic cells lead to the activation of the innate immune response that determines the development and propagation of the inflammation, so that, with reperfusion, the ischaemic damage is exacerbated and accelerated.
Molecules to be removed:
Inflammatory cytokines, toxins
PerLife TM e PerLungsTM