PI: Christopher Hughes, MD
Co-PI: Paulo Fontes, MD
Title: Whole Organ Sonothrombolysis
Description: This technology is a new ex-vivo application for sonothrombolysis (SNT), which combines the use of ultrasound (US) probes and microbubbles timely infused through the arterial port of liver allografts being preserved by a machine perfusion (MP) system. The US probe pulses induces microbubble oscillation and bursting in a process called cavitation. This ex-vivo technology is intended to remove red blood cells (RBCs) plugs and cellular debris from the hepatic arterial peri-biliary plexus (PBP) prior to liver allograft implantation from organs obtained from donors after cardiac death (“DCD”) These patients experience extended periods of hypoperfusion under anoxic conditions prior to organ recovery. The use of DCD livers poses a significant risk for the subsequent development of ischemic cholangiopathy (IC) by the recipient in the post-operative period. IC is an irreversible complication stemming from prolonged ischemia to the PBP leading into recurrent biliary sepsis and subsequent liver allograft failure. This lethal condition requires mandatory retransplantation while yielding prolonged hospital stays and excessive post-operative costs. Previous attempts to prevent IC after DCD liver transplantation using different technologies have failed. IC is caused by progressive clotting of the small blood vessels supplying the PBP, which prevents blood and oxygen from reaching the biliary tree effectively once the liver is transplanted. The ex-vivo SNT technology was designed to remove the clots ex-vivo while enhancing the oxygenation of the bile duct system before the liver is transplanted. It can be used with all current MP systems currently being evaluated for liver preservation.