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. 2012 Jun;64(3):125-43.
doi: 10.1016/j.cryobiol.2012.01.007. Epub 2012 Jan 26.

Persufflation (or gaseous oxygen perfusion) as a method of organ preservation

Thomas M Suszynski  1 , Michael D Rizzari, William E Scott 3rd, Linda A Tempelman, Michael J Taylor, Klearchos K Papas
Affiliations

Persufflation (or gaseous oxygen perfusion) as a method of organ preservation

Thomas M Suszynski et al. Cryobiology. 2012 Jun.

Abstract

Improved preservation techniques have the potential to improve transplant outcomes by better maintaining donor organ quality and by making more organs available for allotransplantation. Persufflation, (PSF, gaseous oxygen perfusion) is potentially one such technique that has been studied for over a century in a variety of tissues, but has yet to gain wide acceptance for a number of reasons. A principal barrier is the perception that ex vivo PSF will cause in vivo embolization post-transplant. This review summarizes the extensive published work on heart, liver, kidney, small intestine and pancreas PSF, discusses the differences between anterograde and retrograde PSF, and between PSF and other conventional methods of organ preservation (static cold storage, hypothermic machine perfusion). Prospective implications of PSF within the broader field of organ transplantation, and in the specific application with pancreatic islet isolation and transplant are also discussed. Finally, key issues that need to be addressed before PSF becomes a more widely utilized preservation strategy are summarized and discussed.

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Figures

Figure 1
Figure 1
Cross-sectional illustration from the anterior view showing a native kidney (A) and kidneys being preserved by A-PSF (B) and R-PSF (C). Note the differences between A-PSF and R-PSF, in particular the relatively pronounced distension of the kidney during A-PSF and the capsular perforations only found with R-PSF – which allow for gas to escape during preservation and reduces overall resistance to gas flow.
Figure 2
Figure 2
Historical timeline of significant contributions to the development of persufflation as a method of tissue and organ preservation
Figure 3
Figure 3
Relative trends comparing number of donation after cardiac death (DCD) liver, kidney, simultaneous kidney/pancreas and pancreas transplants performed in the United States between 2001 and 2009. Data illustrates the increase in DCD liver and kidney transplants over the last six years, with the increase in the number of kidney transplants being due largely to improved preservation protocol, like hypothermic machine perfusion. Data was prepared by the United Network for Organ Sharing (UNOS) on April 30th, 2010.
Figure 4
Figure 4
Total numbers of donation after cardiac death (DCD) transplants performed in the United States between 2001 and 2009, further segregated into transplanted and recovered (but not transplanted) fractions. Additionally, DCD donor livers and pancreata are often not recovered with DCD donor kidneys due to their true or perceived poor quality; these organs (represented by gray bars) are possibly available for recovery and transplant, and may represent target organs for resuscitation via PSF. Data was prepared by the United Network for Organ Sharing (UNOS) on April 30th, 2010.
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