Artificial organs最新文献

Background: The utilization of extracorporeal liver support systems is increasingly prevalent for the management of acute-on-chronic liver failure in clinical settings. Yet, the efficacy of these interventions in terms of tangible clinical benefits for patients remains a matter of debate, underscoring the need for meta-analysis.

Methods: An updated meta-analysis was performed to elucidate the relationship between the application of extracorporeal liver support versus standard pharmacological treatment and the prognostic endpoints of patient survival, specifically assessing 1-month and 3-month mortality rates, as well as the incidence of complications such as hepatic encephalopathy, spontaneous bacterial peritonitis, and hepatorenal syndrome. Literature were searched via PubMed, EMBASE, and Web of Science.

Results: The meta-analysis revealed the following: the odds ratio for 1-month mortality was 0.63 (95% confidence interval [CIs]: 0.51-0.76), for 3-month mortality was 0.70 (95% CI: 0.61-0.81), for hepatic encephalopathy was 0.81 (95% CI: 0.67-0.97), for spontaneous bacterial peritonitis was 0.66 (95% CI: 0.44-0.99), and for hepatorenal syndrome was 0.68 (95% CI: 0.51-0.92). These results suggest that patients with acute-on-chronic liver failure undergoing extracorporeal liver support system therapy have significantly better survival rates and lower complication incidences compared to those receiving conventional drug therapy. Further subgroup analysis indicated that patients with lower model for end-stage liver disease (MELD) scores and reduced total bilirubin (Tbil) levels demonstrated greater benefits from extracorporeal hepatic support.

Conclusion: This study establishes that in the management of acute-on-chronic liver failure, extracorporeal liver support systems confer a survival advantage and reduce complications relative to standard pharmacotherapy.

Introduction: Tracheal decellularization is one of the main processes to provide tracheal substitutes for tracheal replacement. Recently, studies have been held for agents and combinations of processes for tracheal decellularization with different outcomes. This study aimed to evaluate the efficacy of tracheal decellularization by the immunogenic cellular elements using residual deoxyribonucleic acid (DNA) contents (ng/mg) and the preservation of biomechanical integrity by glycosaminoglycan (GAG) content (μg/mg), modulus tensile strength (MPa), ultimate tensile strength (MPa), and stress loading of 50% deformation (N).

Methods: We conducted a meta-analysis based on PRISMA criteria. Data from experimental studies in MEDLINE, Scopus, and ScienceDirect from inception to August 21, 2023, were sought and computed using RevMan 5.4. The outcomes of tracheal decellularization were evaluated through effect size estimates based on pooled Standardized Mean Difference (SMD) with 95% CI.

Results: Tracheal decellularization has significantly reduced the DNA and GAG content after the process (SMD: -11.77, 95% CI [-13.92, -8.62], p < 0.00001; SMD: -6.70, 95% CI [-9.55, -3.85], p < 0.00001). No significant outcomes were observed in modulus and ultimate tensile strength result (SMD: -0.14, 95% CI [-0.64, 0.36], p = 0.58; SMD: 0.11, 95% CI [-0.57, 0.80], p = 0.75). The stress loading of 50% deformation was observed to significantly lower (SMD: -1.61, 95% CI [-2.49, -0.72], p = 0.0004).

Conclusion: Tracheal decellularization has been proven to effectively remove immunogenic cells. However, extracellular matrix integrity and biomechanical properties vary among different decellularization techniques, indicating a need for further refinement to achieve better preservation.

Background: Liver transplantation (LT) is still limited by organ shortage and post-transplant monitoring issues. While machine perfusion techniques allow for improving organ preservation, biomarkers like donor-derived cell-free DNA (dd-cfDNA) and mitochondrial cfDNA (mt-cfDNA) may provide insights into graft injury and viability pre- and post-LT.

Methods: A prospective observational cohort study was conducted on LT recipients (n = 45) to evaluate dd-cfDNA as a biomarker of graft dysfunction during the first 6 months after LT. Dd-cfDNA was quantified on blood samples collected pre-LT and post-LT using droplet digital PCR. In livers undergoing dual hypothermic oxygenated machine perfusion (D-HOPE), total cfDNA and mt-cfDNA levels were measured on perfusate samples collected at 30-min intervals. Correlations with graft function and clinical outcomes were assessed.

Results: Dd-cfDNA levels peaked post-LT and correlated with transaminase levels and histological injury severity. The longitudinal assessment showed that postoperative complications and rejection were associated with an increase in dd-cfDNA levels. Mt-cfDNA levels in D-HOPE perfusate correlated with graft function parameters post-LT and were higher in patients with early allograft dysfunction and severe complications.

Conclusions: This study confirms dd-cfDNA as a marker of graft injury after LT and suggests that perfusate mt-cfDNA levels during D-HOPE correlate with graft function and post-transplant clinical outcome. Integration of these tests into clinical practice may improve transplant management and viability assessment during hypothermic perfusion.