Journal of Artificial Organs最新文献

Chronic kidney disease is a global health issue, and novel therapeutic alternatives to dialysis and kidney transplantation must be developed. Human-induced pluripotent stem cell-derived kidney organoids recapitulate developmental processes and mimic kidney-like structures in vitro and have thus attracted attention for treating chronic kidney disease. However, the limited vascularization and immaturity of human-induced pluripotent stem cell-derived kidney organoids remain major barriers to their clinical application. The latest technological advances and specific challenges in kidney organoid vascularization and maturation were thoroughly examined in this review. Diverse approaches were considered, including coculturing with endothelial cells, in vivo transplantation, applying biomaterials and microfluidic systems, controlling molecular signaling, and metabolic reprogramming. However, issues persist such as low reproducibility, lack of standardization, insufficient functional evaluations, and inadequate safety assessments. Future studies should focus on developing multifactorial and strategies for integrating multiple cell types, establishing maturation assessment criteria, and verifying the long-term functionality and safety of three-dimensional bioprinting technologies. Technologies for the vascularization and maturation of kidney organoids show promise as foundational methods for use innovative regenerative medicine and the development of drug discovery therapies.

Background: To evaluate the feasibility and safety of anticoagulation-free peripheral veno-arterial extracorporeal membrane oxygenation (VA-ECMO) during lung re-transplantation and to assess its impact on blood transfusion requirements and clinical outcomes.

Methods: In this single-center retrospective cohort (January 2023-April 2025), we included adults undergoing bilateral re-do lung transplantation on peripheral VA-ECMO with an anticoagulation-avoidance protocol; primary lung transplants were not included. Data on patient demographics, intraoperative transfusion volumes, postoperative complications, and survival were collected. The primary outcomes were intraoperative packed red blood cell transfusion volume and overall survival; secondary outcomes included incidence of primary graft dysfunction, acute kidney injury, and hemorrhagic and thromboembolic events. Continuous variables are reported as medians with interquartile ranges, and survival was estimated using the Kaplan-Meier method.

Results: Seven patients (median age, 42 years; range, 30-56 years) underwent re-transplantation for chronic lung allograft dysfunction. The median intraoperative transfusion requirement was 560 ml (interquartile range 280-1050 ml). One patient developed primary graft dysfunction of grade 3and two developed stage 3 acute kidney injury requiring renal replacement therapy. Two developed deep venous thrombosis nonrelated to ECMO cannulation; no pulmonary embolism occurred. At a median follow-up of 469 days, all patients survived without evidence of recurrence of chronic lung allograft dysfunction.

Conclusions: Full anticoagulation-free peripheral VA-ECMO during lung re-transplantation is feasible and safe, with acceptable complication rates and potential reduction in transfusion requirements. Larger, multicenter studies are warranted to confirm these findings.

Liver failure, whether due to alcoholic liver disease or hepatic malignancy, often leads to acute-on-chronic liver failure (ACLF), necessitating liver transplantation. A major challenge in managing these patients is the acute decompensation phase, during which hepatic toxins and inflammatory mediators accumulate, resulting in multi-system dysfunction. While liver transplantation remains the most effective treatment, artificial liver support systems, particularly extracorporeal blood purification, offer potential benefits. Hemoperfusion, utilizing solute adsorption via a solid agent, provides an alternative to conventional dialysis, which is limited by membrane permeability. In this case series, we report our experience using HA330 hemoperfusion in combination with standard therapy for liver failure patients treated at our single-center hospital from 2023 to 2024. Extracorporeal blood purification with an adsorptive cartridge (HA330, Jafron, China) was employed as an adjunctive strategy to standard care. Our findings suggest that hemoperfusion may serve as a valuable supportive therapy for liver failure patients requiring transplantation. However, larger cohort studies are necessary to confirm its safety and efficacy.

The performance of semipermeable membranes, and adsorbents incorporated in blood purification devices depends heavily on the design of blood purification devices. No matter how excellent the semipermeable membranes or adsorbents are, if the devices incorporating them are not well designed, the performance of the semipermeable membranes or adsorbents will not be effectively utilized. For this reason, technical know-how is required to optimally design the blood purification devices, and collaboration with different fields is of great help. We will discuss the efforts of our predecessors in interdisciplinary collaboration in the blood purification, as well as the good transmission of gained knowledge.

This study proposes a comprehensive data-driven framework aimed at enhancing organ transplantation efficiency through optimized risk assessment, donor-recipient matching, and equitable organ allocation. Utilizing the gradient boosting algorithm (GBA) for risk prioritization, A* search for optimal donor location, the modified convolutional neural network-based hybrid extreme learning classifier (MCNN-HELM) model for precise matching, and an adaptive objective-weighted genetic allocation (AOWGA) algorithm, the framework addresses critical challenges in organ allocation and distribution. The experimental results indicate strong performance metrics, with the integrated system achieving an overall accuracy of 96%, allocation efficiency of 97%, and a fairness index of 0.92. The MCNN-HELM model showed a matching precision of 0.94 and an accuracy of 97.5%, outperforming existing methods. AOWGA surpassed comparative allocation methods, demonstrating an allocation efficiency of 0.96 and a positive outcome rate of 0.95. By integrating these modules, the framework not only improves organ allocation processes but also enhances survival rates and promotes ethical practices in organ distribution. By innovatively integrating these techniques, the framework reduces waiting times, improves patient outcomes, and ensures fair allocation, marking a significant advancement in addressing the persistent organ shortage and setting a new standard for ethical and efficient organ transplantation.

A 69-year-old male diagnosed with subacute myocardial infarction was subsequently transferred to our institution. Upon admission, echocardiography revealed ventricular septal rupture (VSR). The patient was promptly supported via venoarterial (VA) extracorporeal membrane oxygenation (ECMO) and Impella CP before surgical VSR repair on the 12th day of admission. Following surgery, the patient decided to be transferred to the intensive care unit under new VA-ECMO assistance. Subsequently, Impella CP removal and arterial cannula reinsertion were performed at the ipsilateral site, with no pulsatile bleeding observed from the arterial cannulation site. Emergency aortography revealed a contrast defect at the terminal aorta. Owing to the possibility of acute thrombotic occlusion, the Fogarty procedure was performed through the bilateral common femoral artery (CFA); however, no thrombus retrieved. Contrast-enhanced computed tomography revealed complete occlusion of the bilateral common iliac arteries, extending to the abdominal aorta. The uncontrollable, rapid progression of acidemia resulted in sudden cardiac arrest. Acute arterial occlusion leading to fatal outcomes can occur because of thrombosis following long-term Impella CP use. Impella-associated thrombi can form around the shaft of a mixed area of blood flow caused by the interaction between Impella and ECMO and often develop distal to the aortic arch, which is often overlooked during routine examinations. Therefore, planning for long-term Impella with ECMO support must utilize various imaging modalities to search for thrombi and prepare several means of revascularization during Impella removal.

Venovenous extracorporeal membrane oxygenation (VV ECMO) relies on effective blood drainage, and cannula design plays a crucial role in optimizing blood oxygenation. Recirculation, where oxygenated blood returns to the drainage cannula without systemic circulation, can negatively impact ECMO efficacy. It was hypothesized that drainage cannulae with a longer side hole portion would reduce recirculation and improve blood oxygenation. This in vitro study investigated the impact of the length of the side hole portion and the intervals of the side holes on blood oxygenation in a simulated VV ECMO circuit. Five cannulae were prepared with the following side holes: (a) 1-cm intervals from the tip to 5 cm; (b) 1-cm intervals from the tip to 10 cm; (c) 1-cm intervals from the tip to 15 cm; (d) 3-cm intervals from the tip to 15 cm; and e) 5-cm intervals from the tip to 15 cm. With blood drained from the right atrium and returned to the superior vena cava, recirculation rates and PaO₂ at 150 s after ECMO initiation (descending PaO₂ order) were: (c) 32 ± 1% and 160 ± 4 mmHg; (d) 35 ± 1% and 149 ± 5 mmHg; (b) 38 ± 1% and 139 ± 5 mmHg; (e) 39 ± 1% and 133 ± 4 mmHg; and (a) 57 ± 3% and 94 ± 7 mmHg. These findings suggest that cannulae with a longer side hole portion may optimize blood oxygenation by reducing recirculation. Furthermore, shorter side hole portions on drainage cannulae are not recommended for VV ECMO.