Browsing by Author "Fortuna, Joana Maria Reguengos"
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- Improving organ quality through perfusion during transplant surgeryPublication . Fortuna, Joana Maria Reguengos; Pereira, Maria do Rosário Ramos Caetano; Oliveira, Ana Leite de Almeida Monteiro de; Ribeiro, Viviana PintoPresently, the field of organ transplantation is confronted with a critical scarcity of viable organs, which has a deep impact on the prognosis of patients across the globe. Through the implementation of the Expanded Criteria Donors (ECDs), where organs from donors older than 60 years or older than 50 years with at least two associated risk factors are used for transplantation, it is possible to increase the pool of donors with the additional incentive of earlier transplantation. Nevertheless, the risk of ischemia-reperfusion injury (IRI) may also be increased by the use of ECDs due to the suboptimal status of these organs, leaving them more susceptible to damage and less resilient to the stress of the reperfusion process, which is a major concern in liver transplantation. Consequently, the present thesis overviews novel approaches for organ preservation in order to improve transplants efficacy when using ECDs. A comprehensive evaluation of the current perfusion solutions and organ preservation methods are presented, such as Static Cold Storage (SCS), Normothermic Machine Perfusion (NMP) and Subnormothermic Machine Perfusion (SNMP), with particular emphasis to Hypothermic Oxygenated Machine Perfusion (HOPE). HOPE was applied in this study as organ preservation method due to its unique advantages, such as enhancing mitochondrial function and therefore reducing the liver’s vulnerability to ischemic injury. Thus, the aim of this thesis is to evaluate the efficacy of HOPE in the context of post-transplant surgeries, assessed through the quantitative analysis of Flavin Mononucleotide (FMN) as a prospective biomarker of liver viability. Protocols were meticulously developed and implemented within the hospital setting to ensure that the study followed pre-determined parameters. Donor and recipient information were incorporated into a comprehensive dataset derived from the analysis of six liver transplants. Ultimately, a correlation was established between donor organ data, recipient outcomes, more specifically their clinical analysis, and FMN levels. The findings suggest that FMN analysis has the potential to be a substantial indicator of organ viability, providing the transplant team an additional quantitative approach that can assist in their decision-making. This thesis emphasizes the critical importance for hospitals to implement FMN analysis as a real-time organ viability evaluator, improving transplant success rates and providing a competitive advantage in optimizing the use of ECDs.