April 21, 2017 by Tyler Greer This normothermic perfusion machine pumps the liver with warm, oxygenated blood and nutrition at or just below body temperature for up to 24 hours before transplant. Credit: UAB News

Physicians in the University of Alabama at Birmingham Department of Surgery have transplanted Alabama's first patient with a cadaver liver that was recovered from the donor and "kept alive" and preserved at body temperature instead of the standard cold solutiona technique that enables the patient to receive a liver that surgeons can watch produce bile before it is transplanted.

The transplant was performed recently by UAB Medicine surgeons on Lana Wiggins, a Valley, Alabama, resident, as part of a clinical trial using a normothermic machine perfusion technique developed by OrganOx. Surgeons place the cadaver liver in the normothermic machine, which then pumps the organ with warm, oxygenated blood and nutrition at or just below body temperature for up to 24 hours before transplant. Devin Eckhoff, M.D., director of UAB's Division of Transplantation, says the technique has shown great success in European studies and appears to provide a significant improvement in the quality of the transplanted cadaver organ.

"Because there is a large shortage of livers available for transplantation, the transplant community is continuing to push the boundaries to increase the availability of organs," Eckhoff said. "These normothermic machines enable us to preserve the liver under near perfect physiological conditionsas opposed to the usual hypothermic conditions in which the organ is typically transplanted. With the normothermic preservation, the liver maintains all aspects of graft function throughout the preservation process; it allows for pre-transplant assessment of organ function and thereby viability to predict suitability for implantation and the delivery of potential agents such as stem cells to further improve the tissue damage caused when blood supply returns to the tissue after a lack of oxygen."

UAB's School of Medicine and UAB Hospital have joined 14 other transplant centers in the United States in this study. Research efforts like this clinical trial have focused on overcoming the limitations of cold storage, which is the current universal standard for organ preservation, with a move toward normothermic machine perfusion.

Wiggins, who educated and aided families on the value of being an organ donor as a registered nurse at East Alabama Lanier Hospital for 25 years, says she feels better than she has in three years. That was when the combination of a blood clot, fatty liver disease and medications she had taken her whole life for lupus converged to cause the beginning of liver failure.

"I'm doing fantastic, just wonderful, and I'm already back home doing everything I did before my transplant," said the 63-year-old. "It's ironic that I would be the one in need after all of the years of talking about organ donation with patients or patient families. Even before I was a donor coordinator, I believed in organ donation. I signed up when I was in my early 20s. I'm beyond grateful to have received this gift now."

Normothermic preservation advantages

Although limited in terms of the duration of preservation, cold storage has the major advantages of simplicity, portability and affordability. However, with increased use of marginal organs in recent years because of the dearth of livers available, the limitations of static cold storage are a major factor influencing patient and graft survival rates.

The machine that houses the liver to preserve it prior to transplant is the first completely automated liver perfusion device of its kind. It works similar to a greenhouse, and is constructed from basic components that make up conventional cardiopulmonary bypass, including basic roller pumps, oxygenators and heat exchangers.

"This machine can really help in a number of ways," said Stephen Gray, M.D., liver transplant surgeon and director of UAB's Abdominal Transplant Fellowship. "The fact that the machine can perfuse the organ with oxygenated red blood cells at normal body temperaturejust as it would be inside the bodyand that we can observe it making bile before transplant is just an extraordinary feat, and a significant benefit to us as surgeons and our patients. With these normothermic machine-perfused livers, we can assess whether it is going to work before we transplant it into the patient, whereas we typically do not know if the liver will work until the transplant takes place."

This kind of advancement could mean livers can eventually be shipped from coast to coast in the United States, an impossibility for cold-stored livers. If that is the case, geography would not be as much of a hurdle to transplant those most in need. It also means surgeons would not have to operate overnight if a liver can be kept viable for up to 24 hours.

"You can use a liver for transplant that was placed in cold storage for up to 12 hours; but cooling the organ to ice temperature to slow down its metabolism does not stop it from deteriorating, usually within the first six to eight hours," Gray said. "And if the organ is damaged in some way, perhaps by being deprived of oxygen, the combined effect can be catastrophic for the organ. The perfused machine would allow us to extend the storage time and only enhance the viability of the liver."

Eckhoff added that preliminary evidence from clinical trials in Europe have shown organ preservation by normothermic machine perfusion is superior to static cold storage, a breakthrough that could be a major benefit to those with end-stage liver disease.

"If this is as successful as it appears it can be, it will be a significant benefit to those in need of liver transplantation," Eckhoff said. "About 60,000 patients die of liver disease annually in the United States, and many of them could theoretically have been treated with a liver transplant. This device has the potential to change that radically by enabling us to transplant many organs that are simply unusable with current techniques."

The clinical trial at UAB is expected to last 18 months.

For Wiggins, she is just happy to have a second chance at a healthy life.

"It's hard to describe how you feel about someone who makes the decision to give life to others after they are gone by choosing to be an organ donor," Wiggins said. "I had a cousin who died when he was 19, and his parents donated all of his organshis heart, kidneys, livereverything they could. He was a healthy young boy who helped save several lives. To have someone do the same for me is overwhelming. A tremendous blessing."

Explore further: Organ transplants, deceased donors set record in 2016

Organ transplants performed at the University of Alabama at Birmingham and across the United States in 2016 reached record highs, according to preliminary data from UAB and the United Network for Organ Sharing.

Organ donation after circulatory death (DCD), in which transplant organs are taken from donors after ay period of no blood circulation or oxygenation, is often considered inferior to donation after brain death, in which circulation ...

A new preservation system that pumps cooled, oxygen-rich fluid into donor livers not only keeps the organs in excellent condition for as long as nine hours before transplantation, but also leads to dramatically better liver ...

British surgeons said Friday they have performed successful liver transplants on two patients using a revolutionary technique which keeps the organ warm and functioning while outside the body.

People waiting for organ transplants may soon have higher hopes of getting the help that they need in time. Researchers at the RIKEN Center for Developmental Biology have developed a new technique that extends the time that ...

There's new hope for patients with liver disease who are waiting for a donor liver to become available for transplantation.

A cartilage-mimicking material created by researchers at Duke University may one day allow surgeons to 3-D print replacement knee parts that are custom-shaped to each patient's anatomy.

A collaboration between stroke neurologists at the Medical University of South Carolina (MUSC) and bioengineers at the University of Massachusetts has led to the creation of a realistic, 3D-printed phantom of a stenotic intracranial ...

Just as an athlete might work to build up stamina before a race, a person entering the hospital also can benefit from prepping the mind and body. Even minor adjustments to diet and mental health could help some individuals ...

Having surgery always comes with risks. But a new study suggests a new one to add to the usual list: the risk of becoming a long-term opioid user.

Cher Zhao recently had the rare opportunity to practice skills belonging to the most advanced surgeons: reconstructive cartilage grafting.

Every time you throw a ball, swing a golf club, reach for a jar on a shelf, or cradle a baby, you can thank your rotator cuff. This nest of tendons connecting your arm bone to your shoulder socket is a functional marvel, ...

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Read this article:
UAB performs Alabama's first transplant where cadaver liver is 'kept ... - Medical Xpress

A team of biomedical engineering researchers has created a revolutionary 3D-bioprinted patch that can help heal scarred heart tissue after a heart attack. Two of the researchers involved are biomedical engineering Associate Professor Brenda Ogle (right) and Ph.D. student Molly Kupfer (left). Credit: Patrick OLeary, University of Minnesota

A team of biomedical engineering researchers, led by the University of Minnesota, has created a revolutionary 3D-bioprinted patch that can help heal scarred heart tissue after a heart attack. The discovery is a major step forward in treating patients with tissue damage after a heart attack.

See Also:How 3D Printing Could Revolutionise Organ Transplantation

According to the American Heart Association, heart disease is the No. 1 cause of death in the U.S. killing more than 360,000 people a year. During a heart attack, a person loses blood flow to the heart muscle and that causes cells to die. Our bodies cant replace those heart muscle cells so the body forms scar tissue in that area of the heart, which puts the person at risk for compromised heart function and future heart failure.

In this study, researchers from the University of Minnesota-Twin Cities, University of Wisconsin-Madison, and University of Alabama-Birmingham used laser-based 3D-bioprinting techniques to incorporate stem cells derived from adult human heart cells on a matrix that began to grow and beat synchronously in a dish in the lab.

Watch a video of the cells beating on the patch.

When the cell patch was placed on a mouse following a simulated heart attack, the researchers saw significant increase in functional capacity after just four weeks. Since the patch was made from cells and structural proteins native to the heart, it became part of the heart and absorbed into the body, requiring no further surgeries.

This is a significant step forward in treating the No. 1 cause of death in the U.S., said Brenda Ogle, an associate professor of biomedical engineering at the University of Minnesota. We feel that we could scale this up to repair hearts of larger animals and possibly even humans within the next several years.

Related:Synthetic Cardiac Stem Cells Developed

Ogle said that this research is different from previous research in that the patch is modeled after a digital, three-dimensional scan of the structural proteins of native heart tissue. The digital model is made into a physical structure by 3D printing with proteins native to the heart and further integrating cardiac cell types derived from stem cells. Only with 3D printing of this type can we achieve one micron resolution needed to mimic structures of native heart tissue.

We were quite surprised by how well it worked given the complexity of the heart, Ogle said. We were encouraged to see that the cells had aligned in the scaffold and showed a continuous wave of electrical signal that moved across the patch.

Ogle said they are already beginning the next step to develop a larger patch that they would test on a pig heart, which is similar in size to a human heart.

The research was funded by the National Science Foundation, National Institutes of Health, University of Minnesota Lillehei Heart Institute, and University of Minnesota Institute for Engineering in Medicine.

This article has been republished frommaterialsprovided by University of Minnesota. Note: material may have been edited for length and content. For further information, please contact the cited source.

Reference:

Gao, L., Kupfer, M. E., Jung, J. P., Yang, L., Zhang, P., Sie, Y. D., . . . Zhang, J. (2017). Myocardial Tissue Engineering With Cells Derived From Human-Induced Pluripotent Stem Cells and a Native-Like, High-Resolution, 3-Dimensionally Printed ScaffoldNovelty and Significance. Circulation Research, 120(8), 1318-1325. doi:10.1161/circresaha.116.310277

Continued here:
3D-printed Patch Can Help Mend a 'Broken' Heart | Technology ... - Technology Networks

3D printing incorporating human stem cells might soon become a standard technique for treating heart attack victims, according to US researchers.

Scientists from universities in Minnesota, Wisconsin and Alabama last week unveiled a way of incorporating cells into a bio-printed matrix that will potentially reduce the risk of a second heart attack.

During a heart attack, blood flow to the organ decreases, resulting in massive cell death. These dead cells do not regenerate and are replaced instead by scar tissue which increases the risk of another adverse event.

The US team, led by biomedical engineer Brenda Ogle at the University of Minnesota, used laser-based 3D printing to bind human stem cells into a matrix that at least in a Petri dish in the lab began to beat like heart muscle.

In a further test, the team created 3D-printed heart patches using mouse cells and implanted them into the damaged hearts of lab mice.

After four weeks, the researchers reported "significant increase in functional capacity" in the rodents.

Because the stem cells and supporting proteins used in the biofilm had come originally from each individual animal, the patches became absorbed into each heart. There was no immune system resistance, and no need for follow-up surgery.

Although the technique is still at proof-of-concept stage and faces years of rigorous clinical trials, it represents an important shift towards personalised, regenerative therapies. It also represents a major new direction for 3D printing.

"We were quite surprised by how well it worked given the complexity of the heart," Ogle said. "We were encouraged to see that the cells had aligned in the scaffold and showed a continuous wave of electrical signal that moved across the patch."

Follow this link:
Mending broken hearts - The Sydney Morning Herald