This narrative review explores the role of hemoadsorption (HA) in the treatment of different complications occurring in transplantation medicine, either during the surgical procedures or before surgery in ex-situ organ treatments, noting that the same approach is also performed in the treatment of various life-threatening conditions, such as septic shock, acute respiratory distress syndrome, and cardiogenic shock, all potentially leading to adverse clinical outcomes during transplantation.
In detailing the clinical applications of cytokine adsorption, significant progress is noted across various organ transplants including heart, lung, liver, and kidneys. Particularly in orthotopic heart transplantation, intraoperative cytokine adsorption has demonstrated marked improvements in reducing pro-inflammatory cytokine levels, leading to shorter periods of mechanical ventilation and intensive care stays, thereby enhancing postoperative recovery and potentially improving survival and quality of life.
For lung transplants, the use of cytokine adsorption during ex-vivo lung perfusion has notably improved lung function and reduced inflammation, which is critical given the complexity and high risk of inflammatory complications associated with lung transplants.
Regarding liver and kidney transplants, the review emphasizes that cytokine adsorption has been instrumental in mitigating the inflammatory response immediately post-transplantation. This application helps in preventing acute rejection and enhancing the functionality of the transplanted organs. In liver transplantation, hemoadsorption systems have been effectively utilized to manage complications related to severe liver dysfunction, providing new therapeutic perspectives. These systems facilitate the removal of albumin-bound toxins and water-soluble substances, significantly improving toxin levels in patients suffering from severe liver failure.
Similarly, in kidney transplants, hemoadsorption has been employed to reduce inflammation and enhance both survival and functionality of the transplanted kidneys. This technology offers an innovative approach to manage immune complications and reduce the risk of acute rejection by selectively removing inflammatory mediators and other harmful molecules from the bloodstream.
The review highlights the crucial role of ex-situ hemoadsorption in liver and kidney transplants for reducing inflammation, enhancing organ functionality, and managing severe inflammatory responses to prevent acute rejection. In liver transplants, it effectively addresses complications from liver dysfunction by removing toxins, improving patient outcomes. Similarly, in kidney transplants, it prepares the organs by reducing inflammation, thereby enhancing their functionality and survival, and reducing rejection risks.
Moreover, the review discusses the impact of cytokine adsorption on heart transplants during the cardiopulmonary bypass phase, where it has led to significant reductions in free hemoglobin levels and blood complements C3a and C5a, suggesting a potential role in improving patient conditions during complex cardiac surgeries and reducing complication risks.
Furthermore, the article highlights a prolonged anti-inflammatory effect of cytokine adsorption, as evidenced by increased levels of IL-10, a crucial anti-inflammatory mediator, in patients undergoing cardiopulmonary bypass surgery. This suggests that cytokine adsorption might not only improve immediate transplant outcomes but also have lasting effects that contribute to the survival and functionality of the transplanted organ.
Overall, this review offers a comprehensive view on the role of hemoadsorption in transplant medicine, underscoring that this technology not only enhances immediate clinical outcomes but also contributes to better long-term graft survival.
Read the review at the link: https://www.mdpi.com/2075-1729/14/1/65