HOPE With Cytokine Filtration in Liver Transplantation (Cyto-HOPE)

Summary

Ischemia-reperfusion injury (IRI) is unavoidably typical of solid organ transplantation.

Post-reperfusion syndrome (PRS), characterized by hemodynamic instability at reperfusion of the implanted graft, is a possible complication of liver transplantation. For sure, IRI plays a fundamental role in the multifactorial pathogenesis of PRS.

IRI and PRS are associated with a higher risk of early allograft dysfunction (EAD) and, consequently, graft failure.

Liver grafts from both extended criteria donors (ECD) and donation after circulatory death (DCD) are particularly susceptible to IRI and, accordingly, are at higher risk of PRS, EAD and graft failure. Anyway, in the present scenario of organ shortage, such donors greatly contribute to enlarge the organ pool. So, various strategies have been developed for the purpose of a safer use of this kind of grafts. Among them, ex vivo hypothermic oxygenated perfusion (HOPE) reduces IRI and is beneficial for high-risk liver grafts.

The pathogenesis of IRI is an extremely complex downstream inflammation process, involving many different cytokines, chemokines and growth factors. In particular, tumor necrosis factor-alfa (TNF-alfa), interleukin-6 (IL-6), IL-8 and endothelin-1 (ET-1) are crucial in the development of IRI in liver transplantation.

In experimental models, cytokine filtration during ex vivo lung perfusion (EVLP) was proved to be safe and effective in reducing inflammatory response and, thus, pulmonary edema development.

Since

* in liver transplantation, IRI and PRS are associated with a higher risk of EAD and graft failure
* liver grafts from ECD and DCD are particularly susceptible to IRI and are at higher risk of PRS, EAD and graft failure
* HOPE of high-risk liver grafts reduces IRI
* in solid organ transplantation, various cytokines, chemokines and growth factors are involved in the pathogenesis of IRI
* in experimental models of EVLP, cytokine filtration was proved to reduce inflammatory response and subsequent organ damage,

our hypothesis is that cytokine filtration during HOPE of high-risk liver grafts may potentiate the beneficial effects of HOPE, further reducing IRI and, consequently, further decreasing the incidence of PRS and EAD.

So, the aim of this study is to verify the feasibility and safety of cytokine filtration during end-ischemic HOPE of liver grafts.

Conditions

• Liver Transplantation
• Post-Reperfusion Syndrome
• Ischaemia-Reperfusion Injury
• Early Allograft Dysfunction

Interventions

PROCEDURE

HOPE with cytokine filtration by CytoSorb

Cytokine filtration during HOPE

Sponsors & Collaborators

• Papa Giovanni XXIII Hospital

  lead OTHER

Principal Investigators

• Michele Colledan, MD, FEBS · Papa Giovanni XXIII Hospital

Study Design

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Model

PARALLEL

Eligibility

Min Age

18 Years

Max Age

70 Years

Sex

ALL

Healthy Volunteers

No

Timeline & Regulatory

Start

2021-09-23

Primary Completion

2023-12-31

Completion

2023-12-31

Countries

• Italy

Study Locations