Strategies to improve function of marginal grafts and to recover discharged grafts in liver and kidney transplantation

Bertuzzo, Valentina Rosa (2019) Strategies to improve function of marginal grafts and to recover discharged grafts in liver and kidney transplantation, [Dissertation thesis], Alma Mater Studiorum Università di Bologna. Dottorato di ricerca in Scienze chirurgiche, 31 Ciclo. DOI 10.6092/unibo/amsdottorato/8727.
Documenti full-text disponibili:
[img] Documento PDF (English) - Richiede un lettore di PDF come Xpdf o Adobe Acrobat Reader
Disponibile con Licenza: Creative Commons Attribution Non-commercial No Derivatives 3.0 (CC BY-NC-ND 3.0) .
Download (1MB)


The discrepancy between the number of transplant procedures and the patients in waiting list is linked to the scarcity of suitable donors. Dynamic perfusion of marginal grafts seems to be promising in their recovery. Twenty discarded kidneys were used to perform a preclinical study with a new hypothermic oxygenate machine perfusion. Encouraging preclinical results allowed us to perform a clinical trial, in whom 10 extended criteria donors (ECD) livers and 10 ECD kidneys were perfused with the new machine and then transplanted, and compared with control groups (30 ECD liver transplant and 30 ECD kidney transplant preserved in cold storage). Overall graft dysfunction was 10% in study groups, compared to 31.6% in control group (P < 0.001). The peak of aspartate aminotransferase within 7-days post liver transplant was 637 U/L in control group compared to 344 U/L of liver study group (P = 0.006). Patients receiving a kidney graft with more than 2 hours of hypothermic oxygenate perfusion treatment had lower rate of delayed graft function than control group (0% vs. 40%, p = 0.04). Preclinical analyses demonstrated the absence of damage at histological examination, the improved metabolic activity and a diminished expression of genes related to ischemia/reperfusion injury, especially in case of hyperbarism application during perfusion. Further studies are needed to confirm this hypothesis. On the other hand, the clinical phase of present study documented the safety and efficacy of a new type of machine perfusion, which is low-cost and, unlike the already present in commerce, was effective and safe in both liver and kidney transplantation settings.

Tipologia del documento
Tesi di dottorato
Bertuzzo, Valentina Rosa
Dottorato di ricerca
Settore disciplinare
Settore concorsuale
Parole chiave
liver, kidney, transplant, hypothermic oxygenated perfusion, extended criteria donors, hyperbaric
Data di discussione
10 Aprile 2019

Altri metadati

Statistica sui download

Gestione del documento: Visualizza la tesi