Feasibility of Hypothermic Liver Perfusion

低温肝脏灌注的可行性

• 批准号: 7536720
• 负责人: Kelvin G.M. Brockbank
• 金额: $ 21.55万
• 依托单位: CELL AND TISSUE SYSTEMS, INC.
• 依托单位国家: 美国
• 财政年份: 2008
• 资助国家: 美国
• 起止时间: 2008-09-01 至 2010-02-28
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/7536720
• 关键词: Address; Alcohol abuse; Alcohols; American; Ammonia; Authorization documentation; Bile fluid; Biological Preservation; Blood gas; Buffers; Cause of Death; Cells; Centers for Disease Control and Prevention (U.S.); Cessation of life; Cicatrix; Cirrhosis; Clinical Data; Clinical Research; Condition; Data; Devices; Dialysis procedure; Disease; Electrolytes; Endothelial Cells; Engineering; Enzymes; Evaluation; Factor V; Family suidae; Feasibility Studies; Fibrinogen; Goals; Heart; Heating; Hemoglobin; Hepatitis; Hepatocyte; Hour; Human; Hyaluronic Acid; In Vitro; Indocyanine Green; Injury; Knowledge; Life; Literature; Liver; Liver Failure; Liver diseases; Logic; Measurement; Methods; Modeling; Numbers; Organ; Organ Transplantation; Oxygen; Oxygenators; Patients; Performance; Perfusion; Phase; Phase II Clinical Trials; Physical Dialysis; Preclinical Testing; Probability; Public Health; Range; Regional Perfusion; Relative (related person); Safety; Sampling; Scientist; Small Business Funding Mechanisms; Small Business Innovation Research Grant; Solutions; Staging; Statistically Significant; Surgeon; System; Temperature; Testing; Transplantation; United States Food and Drug Administration; Urea; Veterinarians; Work; base; blood perfusion; cell injury; clinical application; design; improved; in vitro Model; in vivo; liver function; liver preservation; pre-clinical; prototype; research study; success

DESCRIPTION (provided by applicant): More than 43,000 Americans die each year from liver disease, making it the 10th leading disease- related cause of death in the US. Cirrhosis with irreversible injury and scarring of the liver, is the most prevalent cause of liver failure and is attributable to alcohol abuse as well as hepatitis. Although alcohol has been the primary cause of cirrhosis, the Center for Disease Control has predicted that hepatitis-related deaths will increase to 38,000 a year unless improved treatments are developed. The shortage of organs for transplantation continues to be a major impediment to providing optimal treatment for patients with end stage liver failure. There is no dialysis-equivalent therapy for these patients and the prospect of death while waiting for a transplantable organ is a realistic probability. The long-term goal of this SBIR proposal is to increase the number and quality of donor livers available for transplantation by developing a clinically usable, portable, hypothermic perfusion method of liver preservation that will reliably preserve human livers for at least 24 hours. The objective of this Phase I proposal is to test and determine feasibility of an intermediate temperature, 12-14oC, hypothermic oxygenated perfusion strategy in combination with a prototype liver transport device for preservation of porcine heart beating donor liver functions for 24 hours. The prototype liver transport device will be subjected to design review to optimize its design during the course of these experiments. The experimental livers will be compared with fresh untreated controls and livers perfused at 4-6oC under otherwise identical conditions. Both fresh controls and control and experimental hypothermic perfusion groups will be assessed by oxygenated blood perfusion in vitro at 37oC. This normothermic perfusion test circuit will include the liver transport device with additional heat exchange capacity and an oxygenator. During in vitro testing blood gases will be analyzed and both bile and perfusate samples will be collected at frequent intervals. Electrolytes, factor V, ammonia, urea, fibrinogen, hyaluronic acid, indocyanine green clearance and liver enzymes will be assessed in the perfusate or bile samples, as appropriate. If we are successful in this Phase I feasibility study, we will subsequently propose a Phase II study in which porcine liver preservation for 48 hours is attempted and in vitro and in vivo testing is combined with perfusion solution optimization. Forty-eight hours of porcine liver preservation would provide preclinical safety and efficacy data to support progression, with FDA permission, to clinical studies of human livers for up to 24 hours of preservation. PUBLIC HEALTH RELEVANCE: This proposal aims at technical breakthroughs with the potential to address critical national needs for transplantable livers. Conservatively the availability of longer term liver preservation strategies post-mortem may generate significant numbers, equivalent to ~25% more transplantable livers, from expanded criteria heart beating donors and short-term warm ischemic non-heart beating donors.

描述（由申请人提供）：每年有43,000多名美国人死于肝病，使其成为美国第十领先的疾病与死亡原因。肝硬化伴有不可逆转的损伤和肝脏疤痕，是肝衰竭的最普遍原因，归因于酗酒和肝炎。尽管酒精一直是肝硬化的主要原因，但疾病控制中心已经预测，与肝炎相关的死亡人数将增加到每年38,000，除非有改善的治疗方法。移植器官短缺仍然是为终末期肝衰竭患者提供最佳治疗的主要障碍。这些患者没有透析等效疗法，而在等待移植器官的情况下死亡的前景是现实的概率。该SBIR提案的长期目标是通过开发一种可靠的肝脏保存临床，便携式，低温灌注方法来增加可用于移植的供体肝脏的数量和质量，该方法将可靠地保存人类肝脏至少24小时。该阶段提案的目的是测试和确定中等温度，12-14oC，低温氧化灌注策略与原型肝脏传输装置的可行性，以保存猪心脏跳动供体肝功能24小时。在这些实验过程中，原型肝脏传输设备将经过设计审查，以优化其设计。在原本相同的条件下，将将实验性肝脏与新鲜的未处理对照和4-6oc灌注的肝脏进行比较。新鲜对照和对照和实验性低温灌注组将通过37oC的体外含氧血液灌注来评估。该常规灌注测试电路将包括具有额外热量交换能力和氧合剂的肝脏传输装置。在体外测试期间，将分析血液气体，并将频繁地收集胆汁和灌注液样品。电解质，V因子V，氨，尿素，纤维蛋白原，透明质酸，吲哚氰氨基绿色清除率和肝酶将在灌注或胆汁样品中进行评估。如果我们在这一阶段的可行性研究中取得了成功，我们将随后提出一项II期研究，其中尝试了48小时的猪肝保存，并在体外和体内测试与灌注溶液优化相结合。 48小时的猪肝脏保存将提供临床前的安全性和功效数据，以支持FDA许可，并获得对人肝脏的临床研究，以保持24小时的保存。公共卫生相关性：该提案旨在实现技术突破，并有可能满足国家对移植肝脏的关键需求。保守的是，验尸后长期肝保存策略的可用性可能会产生大量数量，相当于可移植的肝脏，这是由于扩展的标准跳动捐赠者和短期温暖的缺血性缺血性非心跳供体。