Source: https://patents.google.com/patent/JP6134771B2/en
Timestamp: 2019-10-17 18:46:14
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Matched Legal Cases: ['art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 140', 'art 140', 'art 140', 'art 140', 'art 140', 'art 140', 'art 140', 'art 140', 'art 140', 'art 140', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art 12', 'art. 12', 'art 12', 'art 12', 'art 12']

JP6134771B2 - Composition, method and apparatus for maintaining an organ - Google Patents
Composition, method and apparatus for maintaining an organ Download PDF
JP6134771B2
JP6134771B2 JP2015240537A JP2015240537A JP6134771B2 JP 6134771 B2 JP6134771 B2 JP 6134771B2 JP 2015240537 A JP2015240537 A JP 2015240537A JP 2015240537 A JP2015240537 A JP 2015240537A JP 6134771 B2 JP6134771 B2 JP 6134771B2
JP2015240537A
JP2016104750A (en
JP2016104750A5 (en
ハッサネイン，ワリード，エイチ．
クーリ，シュクリ，エフ．
クリッテンデン，マイケル，ディー．
バージニウク，ウラジミール
ザ デパートメント オブ ベテランズ アフェアズ
1997-09-23 Priority to US08/936,062 priority Critical
1997-09-23 Priority to US08/936,062 priority patent/US6100082A/en
1998-04-03 Priority to US09/054,698 priority
1998-04-03 Priority to US09/054,698 priority patent/US6046046A/en
2015-12-09 Application filed by ザ デパートメント オブ ベテランズ アフェアズ, ザ デパートメント オブ ベテランズ アフェアズ filed Critical ザ デパートメント オブ ベテランズ アフェアズ
2016-06-09 Publication of JP2016104750A publication Critical patent/JP2016104750A/en
2016-09-15 Publication of JP2016104750A5 publication Critical patent/JP2016104750A5/ja
2017-05-24 Publication of JP6134771B2 publication Critical patent/JP6134771B2/en
Background of the Invention TECHNICAL FIELD The present invention relates to compositions, methods, systems / devices and media for maintaining harvested (extracorporeal) animal organs in a functional and viable state prior to transplantation or reimplantation. In particular, the present invention relates to compositions, methods, systems / devices and media for maintaining a harvested human or human compatible organ in a functional and viable state. Such organs may be evaluated in such a state or may be resuscitated after death.
The present invention also relates to organ perfusion devices, and more particularly to perfusion devices and methods and chemical compositions for extending the shelf life of collected organs.
2. DISCUSSION Although having many aspects, the present invention relates to systems, devices (instruments), methods and media for storing organs in near ideal conditions and physiological conditions. This allows organs to be stored for longer periods of time, reduces high energy phosphate degradation during storage, reduces ischemia and reperfusion injury, and overall results can be improved. Increased shelf life in normal or near normal functional states also provides certain advantages. For example, organs can be transported over longer distances, increasing the time for testing and evaluating such organs.
It is estimated that 1 in 4 patients listed for heart transplantation will die while waiting for the availability of suitable donor organs. Although several advances have made donor organs more available, the achievement of developing donor heart preservation techniques has been lagging behind the demand for heart transplantation. With improved patient survival and the development of new immunosuppressive agents, heart transplantation has become more feasible, making organ supply issues more important. Despite the acceptable clinical results obtained with current donor organ and donor heart preservation techniques, one of the major challenges continues is the safe preservation of donor heart for more than 4 hours. It may be impossible. Extending the storage period to 4 hours or more using current storage techniques significantly increases the risk of organ dysfunction between or after transplantation; this dysfunction is related to the storage period and technique . This 4 hour limit also limits the geographic area in which the donor heart can be transported for successful transplantation. Furthermore, current methods of storing or preserving the heart or other organs preserve the organs in a non-functional state and / or hypothermic state, thus avoiding complete or meaningful testing or evaluation of the preserved organs. Make it possible.
In general, current donor organ preservation protocols do not attempt to reconstruct in vivo-like physiological conditions for harvested organs. Instead, they contain chemical perfusate for up to 4 hours of hypothermia (less than 20 ° C, usually around 4 ° C) and maintenance of the heart (non-pulsatile) or other organs (non-functional). Use save in. These protocols utilize various crystalline cardioplegia solutions that do not fully protect the donor heart from myocardial damage resulting from ischemia and reperfusion injury. The most frequently used cardioplegia preservation solutions are The University of Wisconsin Solution (UW), St. Thomas Solution, and The Stanford University Solution (SU). In addition to myocardial injury, ischemia, reperfusion and / or increased potassium concentration is also believed to be a major cause of recent organ dysfunction, coronary endothelial and smooth muscle disorders leading to coronary vasomotor dysfunction (Ischemia is generally defined as an inadequate blood supply to the myocardium).
Techniques have also been developed for perfusing a preservation solution into the heart at hypothermic conditions. Other organs (liver, kidney, lung, etc.) are maintained in a similar non-functional hypothermic state. The heart or other organ so stored is then transported in this hypothermic state for a maximum of only 4 hours before transplantation.
As is well known in the art, the following principles apply to the preservation of a suitable donor heart or other organ, which is believed to contribute to minimizing ischemia and / or reperfusion injury: a) Minimization of cell swelling and edema; b) prevention of intracellular acidosis; c) minimization of ischemia and / or reperfusion injury; and d) regeneration of high energy phosphate compounds and ATP during reperfusion. Substrate supply. Current methods of hypothermia arrest and stockpiling are known to result in cell swelling, intracellular acidosis, and high energy phosphate degradation. Furthermore, studies in humans clearly show significant endothelial failure after donor heart preservation when utilizing hypothermic arrest and preservation protocols. In some instances, an organ that has undergone hypothermia is transplanted into a recipient that cannot be restarted or resuscitated after transplantation. In addition, in many cases, inadequate storage can cause acute graft dysfunction, and the transplanted organ cannot resume normal function and maintain recipient circulation. The problem of acute graft dysfunction then requires constant support of the recipient's circulatory system by ventricular assist devices and / or cardiopulmonary bypass until it is replaced by another donor heart. In some instances, the proper organ cannot be replaced before the recipient dies. There is also increasing evidence from many recent clinical studies that preservation of metabolism, contraction and vasomotor function is not optimized with current preservation protocols. For example, see Non-Patent Document 1.
In this technical field, organs collected under optimal conditions close to endogenous cannot be preserved, and such preservation is not recognized as feasible or desirable, thus preventing deterioration of the organ state Thus, attempts have been made to use the above combinations of hypothermic conditions and / or crystalline cardiac palsy solutions.
Another approach that has been attempted in the art is to mimic near normal physiological conditions by harvesting almost all donor organs together. For example, Non-Patent Document 2 has developed an automatic perfusion mechanism in which the porcine heart is preserved in a pulsatile state for up to 24 hours by continuously perfusing non-compatible blood. Although this system has shown the potential to safely extend the preservation time of the donor heart, in this method all removal and preservation of the lungs, liver, pancreas, and kidneys in combination with the heart (all together) Is a functional condition, and all still need to be interacted and interdependent so it is very cumbersome and impractical for widespread use.
By providing continuous and easy perfusion, the donor heart or other organs removed from the donor ex vivo or in vivo while maintaining the donor heart or other organs in a normal (beating or functional) state Extension of external storage needs to be achieved in the art. Such technology eliminates the need for cardiac arrest for storage in a hypothermic environment, reduces reperfusion injury, and eliminates many of the problems associated with hypothermia arrest and storage, many of which are clearly time-dependent. Will overcome.
A living body for easily perfusing an excised organ at a normal body temperature (about 20 ° C. to about 37 ° C., preferably about 25 ° C. to about 37 ° C.) in order to extend the preservation of the excised organ up to 24 hours or longer. There is a further need in the art to provide devices, methods and physiological media for the construction of outer circuits. Such devices, methods and media will properly maintain the heart or other harvested organs in a beating or functional state during the storage period and ensure a pulsatile coronary flow and uniform distribution of the substrate. Such devices, systems, methods and media provide for harvesting organs while avoiding time-dependent ischemic injury and ischemia prolongation, thereby preserving coronary endothelial vasomotor function and preventing metabolic degradation of high energy phosphate. Will provide the ability to extend the retention period beyond the current 4-hour limit.
Further, such devices, methods and media could expand the organ donor pool, increase histocompatibility matching time, and potentially reduce the incidence of cardiac allograft angiopathy. It will be appreciated that an extended shelf life of the donor heart will have a dramatic impact on heart transplant practices; global recovery of the organs will be possible, and thus the availability of available organs The pool will increase. Absence of organs due to lack of suitable proximal recipients will be eliminated. In addition, additional time combined with preservation in the functional state, for example, performs organ assessment and testing to determine the immune and functional characteristics of each organ, thereby providing a more complete assessment of the organ and transplantation. The risk of unifunctional failure could be reduced.
Pearl et al., "Loss of Endothelium- Dependent and Produced by the University of Wisconsin Solution." of Wisconsin Solution "), Journal of Thoracic and Cardiovascular Surgery, Vol. 107, no. 1, 1994 January Chien et al., "Canine Lung Transplantation After More Than Twenty-Fours of Normantall Preservation", The Journal of Hourland Venture. 16, no. March 1997
That is, the prior art cannot recognize the feasibility and / or desirability of using near-ideal physiological state ex vivo for harvested organs.
[1] (a) providing an organ that needs to be preserved;
(B) providing an encapsulation means for the organ;
(C) (i) whole blood or leukocyte-free whole blood that is compatible with the organ; and
(ii) (a) metabolic carbohydrates;
(c) potassium ion;
(e) magnesium ions; and
(f) bicarbonate; epinephrine; and adenosine
A storage solution comprising,
And (d) at least one large blood vessel of the enclosed functional organ while maintaining the organ at a normal body temperature of about 20 ° C. to about 37 ° C. Delivering the liquid medium;
A method for preserving a human harvested organ or a human compatible harvested organ in a functional state in a storage period before transplantation,
[2] The method according to [1], wherein the medium contains heparin,
[3] The medium is nitroglycerin, ACE inhibitor, beta blocker, calcium channel blocker, cytoprotective agent, antioxidant, antifungal agent, antiviral agent, antibacterial agent, immunosuppressive agent, non-steroidal anti-inflammatory agent The method according to [1], further comprising a pharmaceutically active agent selected from the group consisting of steroids, and mixtures thereof,
[4] The method according to [1], wherein the medium further contains at least one fatty acid.
[5] The method according to [4], wherein the method includes a further step of delivering the liquid medium to the outside of the organ.
[6] The method according to [1], wherein the method includes a further step of filtering the liquid medium when metabolites derived from the organ accumulate in the liquid medium.
[7] The method according to [1], wherein the method includes a further step of enriching at least a part of the liquid medium with oxygen.
[8] The method according to [1], wherein the method includes a further step of measuring a flow rate of the liquid medium.
[9] The method according to [1], wherein the method includes a further step of measuring the pressure of the liquid medium.
[10] The method according to [1], wherein the collected organ is selected from the group consisting of a heart, kidney, liver, lung, pancreas, small intestine, blood carrying tube, and free muscle flap.
[11] The method according to [10], wherein the organ to be stored is the heart,
[12] The method according to [1], wherein the medium contains insulin.
The present invention provides ideal storage conditions at normal or substantially normal body temperature.
FIG. 1 is a schematic illustration of components that form a perfusion circuit and system according to a preferred embodiment of the present invention. FIG. 2 is a cross-sectional view of a storage chamber for maintaining a donor heart in a beating state according to a preferred embodiment of the present invention. FIG. 3 is a top view of a cover assembly utilized with a storage chamber according to the present invention. FIG. 4 is also a perspective view of a perfusion system installed in a mobile cart for facilitating transport of harvested organs, according to a preferred embodiment of the present invention. FIG. 5 is a schematic diagram of a storage circuit utilizing an integrated container and reservoir in accordance with a preferred embodiment of the present invention. FIG. 6 shows a schematic diagram of another arrangement of storage circuitry and the use of a pulse pump to maintain the heart in an inactive beating state, according to another aspect of the invention. FIG. 7 is a schematic diagram of a storage system and soft shell container for maintaining a kidney in accordance with the teachings of the present invention. FIG. 8 is a schematic diagram of a storage system and soft shell container for maintaining the liver in accordance with the teachings of the present invention. FIG. 9 is a schematic diagram of a storage system and soft shell container for maintaining the pancreas in accordance with the teachings of the present invention. FIG. 10 is a schematic diagram of a storage system and soft shell container for maintaining one or two lungs in accordance with the teachings of the present invention. FIG. 11 is a perspective view of a mobile storage system for maintaining any number of organs in accordance with the teachings of the present invention. FIG. 12 is a work flow diagram according to the method of the present invention.
This aspect is provided by the compositions, methods and systems / apparatus of the present invention. (1) Donor-compatible whole blood (or leukocyte-removed whole blood) and (2) preservation solution containing electrolytes and buffers such as carbohydrate sources, other hormones including insulin and epinephrine, bicarbonate ion source, etc. Providing a liquid or liquid medium. This liquid or liquid medium is delivered to at least one large blood vessel, preferably the “external” portion of such organ that substantially surrounds or bathes the organ. Thus, the compositions, methods, systems / devices and media of the present invention can be used to provide ideal storage conditions at normal body temperature or at a temperature that is substantially normal body temperature so that the organ is functionally Can be maintained.
SUMMARY OF THE INVENTION The present invention provides a human or human compatible harvested organ preservation system that requires preservation or resuscitation during a pre-transplant preservation period or evaluation period, including transplantation or retransplantation. The system of the present invention can also change the geographic location of the transplanted organ during the storage period. This system is:
(A) (i) the organ-compatible whole blood (or leukocyte-removed whole blood) and (ii) an encapsulating means for containing the organ that interacts with a physiological medium or fluid, comprising a preservation solution;
(B) delivery means for delivering the liquid to at least one large blood vessel of the organ;
(C) means for carrying the liquid out of the organ;
(D) temperature control means for maintaining the temperature of the perfusate and the organ at a normal body temperature of about 20 ° C. to about 37 ° C .;
(E) pressure control means for controlling the pressure of the liquid;
(F) oxygen enrichment means for oxygen enriching at least a portion of the liquid;
(G) filtration means for removing undesired filtrate from the liquid, preferably located between the oxygen-enriching means and the organ; and (h) controlling the flow of at least a portion of the liquid. Flow control means;
Such a system optionally includes means for delivering the liquid to the enclosing means such that the exterior of the organ is substantially completely bathed or surrounded by the liquid.
The invention also provides an organ preservation solution for preserving a human or human compatible harvested organ in a functional state at a normal body temperature of about 20 ° C. to about 37 ° C., particularly effective in combination with the systems and methods of the invention. I will provide a. These solutions are:
(1) carbohydrates or other energy sources;
(7) epinephrine; and (8) adenosine,
In addition to fatty acids, these solutions also contain nitroglycerin, ACE inhibitors, beta blockers, cytoprotective agents, antioxidants, antibiotics, antimicrobial agents, antifungals, antivirals, immunosuppressive agents, non-steroidal anti-inflammatory agents It may include a medicament selected from agents, steroids, and mixtures thereof.
In a preferred embodiment, the organ preservation solution is substantially free of non-metabolic impermeants; and has a pH of about 7.4 to about 8.5.
The present invention also provides a method for preserving a human or human-compatible harvested organ in a functional state during a preservation period or evaluation period prior to transplantation or reimplantation. Such a method comprises the following steps:
(A) providing an in vitro organ to be stored or tested;
(C) providing a storage medium or liquid; the liquid medium is:
(i) the organ-compatible whole blood or leukocyte-free whole blood; and
(g) epinephrine; and
(D) delivering fluid over at least one large blood vessel of the encapsulated functional organ while the organ is maintained at a normal body temperature of about 20 ° C. to about 37 ° C. In preferred embodiments, such fluids are also delivered outside the organ.
The present invention provides for the appropriate ex vivo preservation and extension of such preservation of a donor organ or heart in a normal or near normal pulsation or functional state by implementing a method that allows continuous and easy perfusion. Provided systems, instruments, methods and media are provided. According to such systems, devices, methods and media in connection with the present invention, this shelf life can be extended to more than 24 hours while maintaining the heart or other organs alive.
Thus, according to an embodiment, in one aspect, a perfusion device for maintaining a harvested organ during a storage period is provided. Such perfusion devices include a storage chamber for storing the organ during the storage period. A perfusion circuit is provided having a first line for providing oxygen-enriched liquid to an organ and a second line for carrying degraded liquid out of the organ. The perfusion device also includes a device operably coupled with a perfusion circuit for maintaining the organ at a substantially normal body temperature. In addition, the perfusion device maintains the organ in a living state.
In other aspects, the examples provide methods for perfusing an organ or donor heart. Such a method includes providing a storage chamber for receiving an organ and a perfusion circuit operably coupled to such storage chamber. The perfusion circuit includes a first line for delivering fluid to the organ and a second line for carrying fluid away from the organ. Such methods also include the steps of providing several chemical solutions to the liquid in the perfusion circuit and perfusing the liquid to the organ or donor heart.
The compositions, methods, systems / devices and media of the present invention maintain the donor heart in a beating state during the storage period to ensure uniform distribution of the substrate. Maintaining the heart in a beating state further maintains a contractile endothelial vasomotor function in normal metabolism over the 4 hour hypothermic arrest and storage period currently performed for donor heart preservation. To help.
Various advantages of the present invention will become apparent to those skilled in the art upon reading the following specification and appended claims, and upon reference to the following drawings.
The above objects and other objects, features and advantages of the present invention will be described with reference to the accompanying drawings, which, by reference, refer to the same parts throughout the different figures by reference, so that the following more detailed description of preferred embodiments of the present invention. It will become clear. Such drawings are not necessarily to scale or emphasis instead of an explanation of the principles of the invention.
DETAILED DESCRIPTION OF THE INVENTION The present invention relates to a perfusion device and method for extending the storage time of at least one human or human compatible organ, such as a human heart, collected for transplantation or reimplantation.
Referring now to FIG. 1, a perfusion system 10 according to the present invention is shown. Although FIG. 1 shows a scheme of the perfusion system 10, various modifications to this scheme are understood to be within the scope of the present invention. The present invention can be connected to a perfusion system 10 that arbitrarily collects a donor heart in a beating state, keeps the organ in a beating state, and provides a pulsed physiological coronary blood flow. That is, the donor heart need not be stopped before connecting to the perfusion system 10. In addition, the donor heart is not stored in a cardiac arrest hypothermic state during the storage period, thereby eliminating ischemic damage over time. Another advantage of the present invention is that the perfusate used to extend the shelf life consists primarily of autologous blood (preferred) or possibly allogeneic blood circulating in the perfusion system 10. Thus, the donor heart will receive a supply of oxygen and essential nutrients during storage, which keeps the organ alive. In addition, cellular waste is also removed from the organ and filtered out of the perfusion system 10.
The perfusion system 10 is designed to simulate the human circulatory system to keep the donor heart 12 in a beating state for a period of up to 24 hours or longer. As with the human circulatory system, the perfusion system 10 comprises a closed perfusion circuit 14 for circulating a fluid consisting of autologous blood and other chemical compositions to the donor heart 12. That is, the perfusion circuit 14 includes one or more arterial lines 16 for supplying oxygen enriched perfusate to the donor heart 12 and one or more venous lines 18 for carrying degraded perfusate out of the donor heart 12. . As part of the method of the present invention, the arterial line 16 can be used to perfuse the donor organ 12 in both inactive and active states. Hereinafter, this forward perfusion method will be described in more detail.
Still referring to FIG. 1, the donor heart 12 is shown connected to the perfusion circuit 14. The donor heart 12 is confined in a storage chamber 20, which is preferably made of a hard transparent plastic so that the stored organ can be seen. Although the storage chamber 20 is preferably formed of a plastic material such as LEXANO plastic, the storage chamber 20 has a zipper bag (not shown) -like thickness according to the height and shape of the donor heart 12. May be made of soft plastic. If the storage chamber 20 is a rigid plastic container, a plastic cover assembly 22 is used to seal the storage chamber 20 and maintain the sterility and wettability of the donor organ 12. When using a soft plastic storage chamber (not shown), a zipper is used to seal the storage chamber 20 and protect the organ. A suitable drain 24 is provided at the bottom of the storage chamber 20. The drain 24 is connected to the reservoir 30 via the drain line 26, and can return blood that overflows from the organ 12 at the time of attachment or overflows due to liquid leakage that occurs during storage and transportation.
As disclosed, reservoir 30 is designed to contain about 500-3000 ml of liquid. First, the reservoir 30 is primed with 500-2500 ml of autologous or cross-tested blood and then pumped through the perfusion circuit 14. Alternatively, compatible blood or blood substitutes are also included within the scope of the present invention. The reservoir outlet line 32 is connected to the inlet of a centrifugal pump 34 (preferred) that circulates perfusate through the arterial line 16 of the perfusion circuit 14. A preferred pump for this application is Biomedicus 550 manufactured by Medtronic, which moves blood through a magnetic field driven cone. A conventional roller pump may be used, but a magnetic driving force generated by the centrifugal pump 34 is preferable in order to suppress hemolysis of the blood as much as possible. If pulsed flow is desired, pulse pumps such as HEARTMATE® electric assist pump from Thermo-Cardiosystems Inc. or NOVACOR left ventricular assist pump from Baxter Healthcare Corporation pump). Exemplary pulse pumps include those disclosed in Chen et al., US Pat. No. 5,599,173.
Centrifugal pump 34 moves blood through a pump outlet line 36 to a hollow fiber membrane oxygenator 38. The blood is oxygen enriched by the membrane oxygenator 38, preferably using a mixture of 95% O 2 and 5% CO 2 at a rate of 1-2 L / min. Preferred oxygenators include hollow fiber membrane oxygenators such as Monolyth manufactured by Sorin Biomedical and MINIMAX PLUS (trademark) manufactured by Medtronic. Although not specifically shown in FIG. 1, the membrane oxygenator 38 is supplied with oxygen and carbon dioxide through an oxygen bottle 178 with a regulator. Oxygenator 38 also includes a plurality of ports (not shown) that direct pressurized perfusate to other devices. A water heater / cooler 40 supplies warm water through a water circuit 42 that keeps the liquid in the perfusion circuit 14 at about 37 ° C. (normal body temperature). The warm perfusate then keeps the donor heart 12 at a normal body temperature. Alternatively, the water heater 40 can take heat away from the water circulating through the water circuit 42 to cool the perfusate in the perfusion circuit 14. Heat can be taken away for various reasons. For example, if the device / system 10 is storing the organ 12 in an environment that is too warm (ie, exceeding normal body temperature), heat from the liquid can be prevented to prevent the temperature from exceeding 37 ° C or some other predetermined temperature. I can take it away. Heat can also be taken from the liquid to cool it below 37 ° C., which is desirable when inducing the preserved organ 12 to a lower normal body temperature and / or a mild hypothermia state. This is desirable even before the organ 12 is stopped. Sufficient heat may be taken to reduce the temperature of the fluid and organ to about 20 ° C. Oxygenator outlet line 44 carries oxygen enriched and reheated liquid to filter 46. The liquid is preferably filtered with a leukocyte filter such as a Pall leukocyte removal filter manufactured by Pall Filters.
The outlet of the filter 46 is connected to the selector valve 50 via a filter outlet line 48. The selector valve 50 allows fluid flow to either the initial perfusion line 52 (for forward perfusion through the aorta), the left atrial supply line 54 (for forward perfusion through the left atrium), or both lines simultaneously (for priming). It can be placed in one of a plurality of positions for facing. Further, the selector valve 50 may be completely stopped. As can be seen, the lines 48, 54 and possibly the lines 52 and 58 form the arterial side 16 of the perfusion circuit 10. The opposite end of the initial perfusion line 52 is connected to a tee 56 which then branches into an aortic line 58 and an afterload column line 60. A straight connector 61 is used to connect the line 60 and the aorta return line 62. A luer port 63 to which a siphoning prevention valve is fixed is fixed to the connector 61, and the liquid pumped across the connector 61 siphons excess liquid from the rear load line 60. It acts as a one-way valve that allows it to flow through the aortic return line 62 without it. The luer port 63 serves to force air into the aorta return line 62 to break the liquid siphon effect. That is, the top of the afterload column 60 is formed by the connector 61 and the luer port 63.
The distal end of the afterload line 62 is attached to the reservoir 30 to allow blood pumped through the aorta 130 to return to the reservoir 30. As described in further detail below, the aortic line 58 provides bi-directional flow in the donor heart 12 depending on the mode of operation of the perfusion system 10. The height of the afterload column 60 is adjustable within a certain vertical position range to selectively change the afterload pressure where the heart 12 beats or pumps against it. As the liquid pumped through the afterload column 60 traverses the connector 61, it is returned to the reservoir 30 via the aortic return line 62. A right ventricular return line 64 is connected to the pulmonary artery 132 to return coronary effluent to the reservoir 30. As shown, lines 58, 60, 62 and 64 form the venous side 18 or delivery means of perfusion circuit 14 when the heart is in motion.
Aortic flow is measured by an ultrasonic flow probe 66 that forms part of the aortic line 58. Similarly, the ultrasonic flow probe 68 measures coronary blood flow from the right ventricle to the reservoir 30 through the right ventricular return line 64. The aortic and coronary flow signals generated by the ultrasonic flow probes 66 and 68 are recorded with a two-channel flow meter 70 that assists in monitoring the condition of the preserved organ 12 and the performance of the perfusion system 10. A preferred flow meter 70 for use with the present invention is a two-channel flow meter manufactured by Transonic Systems.
The coronary flow was kept within an acceptable physiological range (300-500 ml / min) by adjusting the height of the afterload column 60 above the heart 12 and adjusting the flow rate provided by the pump 34. It is. The afterload pressure is maintained at about 70 mm mercury column, but may be adjusted as needed. A microchip pressure catheter 72 is inserted into the left ventricle via the left atrium 134 to measure the intracavity pressure of the donor heart 12. A preferred pressure catheter 72 includes a type manufactured by Millar Instruments. All pressure measurements generated by the pressure catheter 72 are recorded and displayed using a digital pressure recording system 74 that also assists in monitoring the condition of the preserved organ 12. As disclosed, the pressure recording system 74 can record and display a number of pressure measurements.
One of the ports exiting the oxygenator 38 is connected to a supply line 76 that supplies oxygen-enriched blood to a drip manifold 80. As disclosed, three IV bags 82, 84, 86 are connected to the drip manifold 80 to supply various chemical compositions to the preserved organ (described in further detail below). The drip manifold 80 is known in the art and provides a mechanism for receiving each drip rate adjusted chemical solution stored in IV bags 82, 84, 86. As is known in the art, the drop rate can be adjusted by an infusion pump (not shown). Manifold outlet line 78 carries blood enriched with various chemical solutions to reservoir 30 for circulation to donor heart 12.
A variety of materials can be used to make the various lines and elements of the perfusion system 10. Since almost all lines and elements of the perfusion circuit 14 are always in contact with blood perfusate, it is desirable to suppress the acute inflammatory response caused by blood exposure to the extracorporeal artificial surface. To solve this problem, all contact surfaces in the perfusion circuit 14 may be coated or bonded with heparin to reduce complement and granulocyte activation. Alternatively, heparin may be introduced directly into the fluid circulating through the perfusion circuit 14 or other biocompatible surfaces may be utilized for the circuit 14.
Further, the operation of the perfusion system 10 will be described more specifically with reference to FIG. As described above, the donor heart is collected in either a beating state or a stopped state and placed in the storage chamber 20. At this point, centrifugal pump 34 pumps oxygen enriched and rewarmed blood through line 48. During priming, the selector valve 50 is placed at a position that allows blood to pass through the initial perfusion line 52 and the left atrial supply line 54 simultaneously. Once the arterial line 16 of the perfusion circuit 14 is primed sufficiently to eliminate the presence of bubbles or air pockets, the valve 50 is rotated to a position to supply fluid to the initial perfusion line 52. The aortic line 58 is then connected and secured to the aorta 130 using the aortic cannula 120. This procedure causes blood to flow into the aorta line 58 and immediately perfuse the inactive beating donor heart 12 through the aorta 130. Alternatively, the afterload line 60 may be clamped to maximize blood flow to the aorta 130. This procedure of forward perfusion through the aorta 130 is carried out for about 10-15 minutes in order to stabilize the donor organ and to ensure device attachment time. The remaining flow line is connected to the donor heart 12 when the device is installed. More specifically, the connection between the aortic line 58 and the aorta 130 is complete, the supply line 54 is connected to the left atrium 134, and the right ventricular return line 64 is connected to the pulmonary artery 132. The pulmonary vein, superior and inferior vena cava are then ligated closed using # 0 suture silk. During the initial connection protocol, effluent blood is trapped in the storage chamber 20 and returned to the reservoir 30 via the drain line 26.
At the end of the stabilization phase, the flow to the left atrium 134 via the left atrial supply line 54 is simultaneously and gradually increased, and the selector valve 50 that gradually blocks the flow through the initial perfusion line 52 is rotated to the normal operating position. By doing so, the flow to the aorta 130 is reduced. The afterload line 60 is also unclamped. This procedure then switches the donor heart 12 from an inactive state to an active state in which blood is pumped by the donor heart 12 through the venous line 18 of the perfusion circuit 14. It is particularly noted that the donor heart 12 always keeps beating. Blood flow to the donor heart 12 through the arterial line 16 is assisted by a centrifugal pump 34. The donor heart 12 is pulsated against the afterload pressure caused by the vertical position of the afterload column 60 above the storage chamber 20, thereby generating a pulsed coronary flow. Also, oxygen-enriched blood is supplied to the coronary vasculature, and deoxygenated blood coming from the coronary vasculature is pumped from the right ventricle to the pulmonary artery return line 64 and returned to the reservoir 30. At this point, the donor heart 12 can remain live and beating during the storage period. While the perfusion system 10 has been specifically described for use in preserving the heart, the apparatus and method of the present invention can be cannulated in an artery of an organ using line 54, except for lines 52, 58, 60 and 62, It is particularly suitable for the purpose of extending the storage time of any solid organ by cannulating the vein of the stored organ using line 64. That is, the perfusion system 10 can preserve organs including the kidney, liver, lungs, pancreas, and small intestine for a long period of time.
Turning now to FIG. 2, the storage chamber 20 and connections between the various cannulas and the donor heart 12 are shown in more detail. As disclosed, the storage chamber 20 has an open top, a generally cylindrical sidewall 90 and a gradient bottom that facilitates liquid flow to the drain 24 for return to the reservoir 30 via line 26. 92. During device installation and storage, the gradient bottom 92 further houses the donor organ 12 in a more correct anatomical location. The upper end of the cylindrical side wall 90 includes a flange 94 that projects outwardly to surround the periphery to provide yet another surface for receiving the cover assembly 22.
The elements of the cover assembly 22 will now be described in more detail with reference to FIGS. The outer periphery of the cover assembly 22 is formed by a clamping ring 96 with two halves connected by a hinge 98. The two halves of the clamping ring 96 can be visibly fixed via a snap lock 100. The remaining portion of the cover assembly 22 is formed by a first cover 102 and a second cover 104 that integrally form a circular cover plate having an aperture in the center for receiving the cannula plate 106. Clamping ring 96 has a generally U-shaped cross section designed to receive flange 94 and first and second covers 102, 104 to create a hermetic seal, as shown in FIG. The adjacent edge 105 between the first cover 102 and the second cover 104 has a tongue-and-groove structure (not shown) to provide additional rigidity and sealing to the cover assembly 22. It has. Similarly, the cannula plate 106 is an annular tongue that fits within an annular groove 110 formed within the first cover 102 and the second cover 104 to secure the cannula plate 106 within the cover assembly 22. 108 is provided. The tongue groove configuration associated with the adjacent edge 105 is not specifically shown, but those skilled in the art will appreciate that this configuration is substantially similar to the ring tongue 108 and ring groove 110 configurations. You will easily recognize it.
Although there are several variations that make up the cover assembly 22, it is preferred that the first cover 102 and the second cover 104 be permanently secured to each side of the clamping ring 96. In this case, the annular channel 112 remains along the lower inner circumference of the clamping ring 96 to receive the flange 94 when the cover assembly 22 is placed at the upper end of the storage chamber 20. When the annular channel 112 is properly mated with the flange 94, both halves of the clamping ring 96 are integrated to firmly tighten the snap lock 100 so that the cover assembly 22 can sterilize and wet the encapsulated organ. Gender can be kept appropriate.
Another advantage that the cover assembly 22 provides is that the cannula plate 106 is a separate element that interlocks with the first and second covers 102, 104 of the cover assembly 22 when installed and secured. is there. Thus, the various cannulas that are secured within the cannula plate 106 can be attached in the correct location on the organ 12 prior to attachment of the cover assembly 22. The cannula plate 106 also serves to place each cannula in the correct position when connecting the organ 12 to the perfusion system 10. More particularly, the cannula plate 106 includes a first aperture for receiving the aortic cannula 120, a second aperture for receiving the arterial cannula 122, and a third aperture for receiving the left atrial cannula 124. And a fourth aperture for receiving the pressure catheter 72. Each individual cannula is fitted into cannula plate 106 to provide a strong connection. In addition, each cannula shall have a standard sized top tube for fitting into the cannula plate 106 and a flared lower tube of various sizes for fitting within the associated artery or vein. Thus, if a cannula having a smaller or larger lower tube is required, it can be fitted to the cannula plate 106 without removing the other cannula. That is, the design of the cannula plate 106 provides a modular element that integrates easily and tightly with the cover assembly 22.
In operation, the fully assembled cannula plate 106 can be secured with the aorta 130 connected to the aortic cannula 120, the pulmonary artery 132 connected to the arterial cannula 122, and the left atrial cannula 124 correctly inserted into the left atrium 134. Thus, it is placed in a state close to the beating organ 12. A surgical cable tie (not shown) is preferably used to secure the aorta 130 around the aortic cannula 120 and to secure the pulmonary artery 132 around the arterial cannula 122. The left atrial cannula 124 is secured in the left atrium 134 using a size 2-0 surgical prolene suture. As disclosed, the surgical cable tie provides a leak proof seal and a larger surface area for suturing the arteries surrounding the cannula without risk of tissue damage. In turn, this helps to properly support the donor heart 12 within the storage chamber 20. In some instances, such as in the case of a smaller donor heart 12, the heart may be suspended by the aorta 130 in the storage chamber 20.
After properly securing the organ to the elements of the cannula plate 106 in the storage chamber 20, each half of the lid assembly 22 is secured so that the cover assembly 22 is fixed to the upper end of the storage chamber 20. It can be fitted around the outer periphery of the cannula plate 106. The cover assembly 22 and cannula plate 106 then serve to suspend the donor heart 12 within the storage chamber 20. As best shown in FIG. 2, pulmonary artery line 64 is secured to arterial cannula 122, aortic line 58 is connected to aortic cannula 120, and left atrial supply line 54 is connected to left atrial cannula 124. Once all connections are correct (about 15 minutes), the organs are beaten for about 10-15 minutes in the inactive state as described above for stabilization. After completion of the stabilization and attachment phase, the donor heart is beaten in an active state against the afterload created by the afterload column 60. The preserved organ may continue to beat in an active state for up to 24 hours or more during the preservation period.
According to studies conducted using the perfusion system 10 to assist the animal heart, the device and method of the present invention beats preserved organs for up to 24 hours with little or no myocardial damage. Can be kept in a state. As part of a preliminary study with animal hearts, blood electrolytes in donor hearts kept in a beating state were measured at 1 hour, 6 hour, and 12 hour intervals. In the analysis of blood electrolytes, glucose, sodium (Na), chlorine (Cl), potassium (K), calcium (Ca), and bicarbonate HCO3 are kept at substantially baseline values during storage It has been shown. That is, according to the apparatus and method of the present invention, the donor heart is kept in a strong beating state over a period exceeding the 4 hour time limit associated with existing hypothermic arrest preservation methods.
Three types of chemical solutions that function in the preservation of the organ 12 are also relevant to the apparatus and method of the present invention. As disclosed, these three chemical solutions replenish the energy consumed by cellular activity into the preserved organ, keep the blood electrolyte at a physiological level, stimulate the cardiac contraction system and preserve the donor heart during the preservation period. Is kept in a beating state. The three chemical solutions are supplied to the reservoir 30 through a drip manifold 80 that assists in adjusting the appropriate drip rate for each chemical solution, as previously described. The first solution is stored in the IV bag 82, the second solution is stored in the IV bag 84, and the third solution is stored in the IV bag 86.
Prior to perfusing the organ 12, the perfusion system 10 should be prepared with 100-250 ml of primary solution (stored in IV bag 82), 12.5-25 mg mannitol (complex sugar) or a suitable alternative, and 125-250 mg. Prime with methylprednisolone sodium succinate or a suitable alternative. This mannitol acts as an impeller to increase the osmotic pressure of the perfusate, which acts to suppress or reduce edema formation in the preserved organ. Mannitol also acts as an oxygen scavenger or free radical scavenger that mitigates the adverse effects of reperfusion injury and extracorporeal perfusion on preserved organs. Furthermore, mannitol is particularly useful when the perfusate contact surface of the perfusion circuit 14 is not heparinized. However, mannitol can take full advantage of the benefits provided by mannitol, even when all elements of perfusion circuit 14 have a heparin binding surface, when used therein. Methylprednisolone sodium succinate is a steroid that acts as a cell membrane stabilizer to prevent cell lysis during reperfusion and also acts as an immunosuppressant.
As disclosed, the first solution or primary solution is a solution consisting of sugar and various electrolytes. The first solution is a mixture of several chemical compositions and 1 liter dextrose, preferably 5% (preferably in the range of 2.5% to 5% dextrose) in normal saline (0.9 molar sodium chloride). To be prescribed. Alternatively, dextrose may be delivered in semi-normal saline (0.45 molar sodium chloride). Dextrose is one of the main components required by preserved organs for cellular energy and ATP production. Dextrose is a form of glucose that acts by stimulating the aerobic pathway of glycolysis and the Krebs circuit, and is the primary biochemical process for generating internal energy. To this dextrose solution is added 4 milliequivalents of potassium chloride (preferably in the range of 4 meq to 6 meq). The purpose of this potassium chloride is to prevent arrhythmia (abnormal heart rhythm) by keeping intracellular and extracellular potassium at normal physiological levels. 35 units of regular insulin (preferably in the range of 20 units to 40 units) is also preferably added to the primary solution. Insulin acts to move glucose into the cell, making it readily available for cytoplasmic and mitochondrial metabolic processes. Insulin also helps to move extracellular potassium into the cell and ensure physiological potassium levels. It is also preferred to add 1.5 grams of calcium chloride (preferably in the range of 1.0 to 1.5 grams of calcium chloride). Calcium chloride is the major cation required for myocardial contraction and its presence at normal physiological levels is important to keep the donor heart in a beating or active state. Calcium chloride also acts as a positive inotropic agent to increase myocardial contractility and is also necessary for normal myocardial function during preservation of beating donor hearts. The primary drop solution stored in the IV bag 82 is supplied to the drop manifold 80 at a preferred drop rate of 15 ml / hour (preferably in the range of 15 ml / hour to 40 ml / hour). In another embodiment of the primary solution, preferably 5 ml of sodium bicarbonate (preferably in the range of 5 ml to 10 ml) is added to the solution bag to maintain a normal pH of 7.4 to 7.5. That is, the addition of sodium bicarbonate acts to buffer the solution.
The disclosed second solution is preferably a fatty acid solution, ie a saturated and / or unsaturated monocarboxylic acid solution. C3-C10, C3-C8 chain fatty acids, preferably both single and long chain fatty acids including C3, C7 or C8 chain fatty acids can be used. In a preferred embodiment, this object is achieved by a 20% intralipid solution (preferably using a range of 10% to 20%). The preferred concentration of intralipid solution is currently available from commercial manufacturers as 10% intralipid solution or 20% intralipid solution. Alternatively, soybean-based soyacal that provides fatty acids may be used. The intralipid solution is supplied to the dropping manifold 80 at a preferred rate of 2 ml / hour (preferably in the range of 1 ml / hour to 2 ml / hour). Intralipid solutions are preferred for use with the present invention because of the high content of fatty acids that can be directly metabolized by donor heart cells. Fatty acids are the primary source of cardiomyocyte energy. The secondary source of cardiomyocyte energy is glucose supplied by the first drop solution.
The third solution disclosed is preferably prepared by mixing 250 ml normal saline (preferably in the range of 250 ml to 500 ml) and preferably 4 mg of epinephrine (preferably in the range of epinephrine 4 mg to 8 mg). The This solution is used to supply the donor heart with the baseline catecholamines necessary for normal heart rate and contractility. Epinephrine is also used for the purpose of keeping the heart rate within the normal physiological range. Epinephrine acts by stimulating receptors in the sympathetic nervous system of the preserved heart. In a study conducted in parallel with the present invention, when the serum catecholamine level was measured frequently, the plasma catecholamine level significantly decreased after 2 to 6 hours of storage in the perfusion system 10. It has been shown. The third solution is fed into the drip manifold 80 at a preferred drip rate of 4 ml / hr (preferably in the range of 2 ml / hr to 12 ml / hr) to maintain baseline values of catecholamines. In yet another embodiment of the third or epinephrine solution, preferably 2 ml of sodium bicarbonate (preferably in the range of 2 ml to 5 ml) is added to the solution bag to maintain a normal pH of 7.4 to 7.5. . That is, the addition of sodium bicarbonate acts to buffer the solution.
Since the preserved organ 12 is kept in a beating state, it is important that oxygen-enriched blood is supplied to the heart at a normal body temperature. The preserved organ must also be supplied with a balance substrate consisting of the three chemical solutions already disclosed. In addition, since the storage period is up to 24 hours or longer, the storage organ 12 is supplied with a large amount of energy and supplemented with various chemical compositions in order to maintain normal pulsatile operation. I have to. As part of another preferred embodiment, the fatty acid can be delivered into the liquid medium via the solution bag 274 and the remaining chemical composition can be delivered into the liquid medium via the solution bag 272.
Turning to FIG. 4, the perfusion system 10 is shown installed in the mobile cart 140. As disclosed, the cart 140 includes an upper shelf 142, a middle shelf 144, and a lower shelf 146 supported by four posts 148. The lower end of each post 148 includes a locking caster 150. Two of the posts 148 engage a pair of adjustable poles 152, 154. The height of each pole 152, 154 can be adjusted using a threaded locking knob 156. The pole 154 includes an adjustable arm 158 whose primary purpose is to support lines 60 and 62 for setting the height of the afterload column 60. The adjustable arm 158 includes a threaded locking knob 160 for setting the height of the adjustable arm 158 and a hook portion 162 for supporting the lines 60, 62 at its outer end.
The upper shelf 142 of the cart 140 includes a circular aperture and an annular clamp 170 for receiving and securing the storage chamber 20. As disclosed, the storage chamber 20 is fitted into an annular clamp 170 and secured with a plurality of thumbscrews 172. Although not specifically shown, the annular clamp 170 and the thumbscrew 172 may be replaced by an annular clamp operated by a release lever for securing the storage chamber 20. The upper shelf 142 is also provided with a rectangular aperture 174 that lowers the various lines from the storage chamber 20 to the lower element. The middle shelf 144 also includes a rectangular aperture 176 that provides a similar function. As disclosed, the reservoir 30 is placed directly below the storage chamber 20 on the middle shelf 144. The middle shelf 144 also includes an oxygen bottle and regulator 178 for supplying the membrane oxygenator 38 with the necessary oxygen and carbon dioxide mixture. Lower shelf 146 is particularly suitable for supporting centrifugal pump 34, membrane oxygenator 38, and water heater 40. These are usually the heaviest of the elements that engage the perfusion system 10, so that these elements are located on the lower shelf 146, helping to lower the overall center of gravity. The cart 140 is further stabilized. Upper shelf 142 provides sufficient surface area to support flow meter 70 and digital pressure recording system 74. However, additional electronic measurement and feedback instruments may be supported by the upper shelf 142 for use with the perfusion system 10. Finally, a transparent hard plastic cover 180 can be placed over the upper end of the cart 140. The cover 180 allows macroscopic observation of elements placed on the upper shelf 142 and further protects the perfusion system 10 and the storage chamber 20.
As those skilled in the art will appreciate, the mobile cart 140 provides significant enhancements to the overall functionality of the perfusion system 10. More specifically, the perfusion system 10 can be trolleyed from another storage location to the operating room. Further, the cart 140 can be easily moved in one or a plurality of operating rooms at the time of organ collection and organ implantation. In addition, the locking caster 150 secures the cart 140 in one position that prevents unwanted movement. The overall size of the mobile cart 140 is such that it can be easily transported either on land transportation means such as ambulances, or in private or commercial aircraft such as hospital helicopters or airplanes. That is, the mobile cart 140 serves to increase the overall efficiency of transport of organs collected for implantation into the recipient.
Turning now to FIG. 5, according to another preferred embodiment, a storage system 200 of the present invention is shown. It is noted that the storage system 200 shares many of the same elements as the perfusion system 10 disclosed above and operates in a similar manner. That is, the storage system 200 also serves to reduce or eliminate ischemia over time associated with the prior art, suppress or eliminate edema, and supply a chemical strengthening agent to the preserved organ by a physiological method. However, some improvements associated with the storage system 200 are described in further detail below. This configuration of the storage system 200 collects the donor heart 12 in either a pulsating state or a non-pulsating (stopped) state, connects it to the storage system 200, and maintains the pulsating state so that the physiological of the storage solution Also try to receive the supply of coronary flow.
As specifically shown in FIG. 5, physiological coronary flow is delivered in a pulsed state because the heart is beating in an active state to produce its own pulsed flow. As already mentioned, the liquid medium used to extend the shelf life is mainly composed of autologous, homogenous or compatible blood circulated through the storage system 200. One of the advantages. The chemical toughening agent described herein is then mixed with blood to prepare a preservation medium. That is, the donor heart 12 is supplied with oxygen and various chemical enhancers during the storage and maintenance period to keep the organ alive. For the purposes of the present invention, a living state refers to a state in which an organ is functioning at a physiological level. In addition, cellular waste products and metabolites are transported out of the organ in normal physiological conditions and filtered out of the storage system 200. Alternatively, cellular waste products and metabolites can be diluted or removed from the storage system 200 by transfusion of the blood in the reservoir. Furthermore, cellular waste products and metabolites can be removed with a suitable hemodialysis filter.
The storage system 200 is designed to simulate an in vivo human circulatory system to keep the donor heart 12 in a beating state for up to 24 hours or more. This storage technique can be operated at a normal body temperature of about 37 ° C. or at a substantially normal body temperature of about 20 ° C. to about 37 ° C. As disclosed above, the storage system 200. It comprises a closed storage circuit 202 for circulating a fluid medium comprising a chemical composition comprising autologous or allogeneic or compatible blood or blood substitutes and other storage solutions to the donor heart 12. As disclosed, the blood may be either whole blood that is compatible with the organ or whole blood from which leukocytes have been removed. As shown, the storage circuit 202 includes one or more arterial lines 16 for supplying oxygen-enriched liquid to the donor heart 12 and one or more venous lines for carrying degraded liquid from the donor heart 12. 18. According to this aspect, the arterial line 16 comprises delivery means for delivering a fluid medium to at least one large blood vessel of the organ, and the venous line 18 comprises means for carrying the fluid medium out of the organ. As part of the method of the present invention, arterial line 16 is used to supply and / or perfuse fluid to donor organ 12 that is either inactive or active.
With further reference to FIG. 5, the donor heart 12 is shown connected to the storage circuit 202. The donor heart 12 is confined in an enclosing means 206 for containing the donor heart in communication with the liquid medium. As disclosed, the enclosing means 206 is a rigid plastic chamber for protecting and making the stored organ visible. The enclosing means or storage container 206 is preferably made of transparent polycarbonate or other suitable rigid plastic material. As disclosed, the enclosing means 206 may consist of a thick but soft, plastic plastic container in the form of a bag having a single or double zip-lock closure. The bag is preferably formed to fit the height and shape of a preserved organ such as donor heart 12 or other solid organ.
As shown, the storage container 206 forms part of an integrated storage device 204 that also includes a hollow fiber membrane oxygenator 208 and a heat exchanger 210. As part of this embodiment, the oxygenerator 208 comprises oxygen enriching means for oxygen enriching at least a portion of the liquid medium, and water for supplying the heat exchanger 210 and associated temperature controlled water. The heater / cooler unit 236 comprises temperature control means for maintaining the temperature of the organ at about 20 ° C to about 37 ° C. As can be seen, the storage container 206 is substantially similar to the storage chamber 20 disclosed above, but as part of the present invention, the storage container 206 stores a supply of storage liquid or liquid medium. In order to form the liquid reservoir 212 for the purpose at the same time, it is slightly larger. As shown, the storage container 206 is preferably large enough to form a liquid reservoir 212 for containing about 500-3000 ml of liquid. This design feature allows the donor heart 12 to be substantially immersed and / or bathed in the liquid in the storage container 206 as needed.
The storage container 206 has an open top and is formed by a generally cylindrical sidewall 90 and has a sloped bottom 92 that facilitates liquid flow to the reservoir outlet 222. The upper end of the cylindrical side wall 90 also includes a flange 94 projecting outwardly to surround it to provide a further surface for receiving the cover assembly 22, as shown in FIG. ing. The remaining portion of the cover assembly 22 is substantially similar to that disclosed above, except that multiple blood inlets or ports 292 and one or more safety valves 294 are added.
The storage container 206 also includes a pair of filters 214 that serve to remove particulate matter from the storage liquid. Each filter 214 is preferably made of polyurethane sponge. That is, the filter 214 forms part of a filtering means for removing undesirable filtrate from the liquid medium. One end of each filter 214 includes a silicon antifoam screen 216 that further assists in reducing and / or removing bubbles and foam from the recycle stock solution. A silicon foam pad 218 is placed in the lower portion of the storage container 206 to support the donor heart 12 during the storage period. The silicon pad 218 also acts as a shock absorbing sponge. As shown, a further port 224 having a stopcock 226 is also provided if it is desired to drain the storage fluid in the liquid reservoir 212 during operation of the storage circuit 202.
An outlet line 228 is provided for connecting the reservoir outlet 222 with the centrifugal pump head 230. A pump head driver 232 is provided that creates the rotational force and control applied to the pump head 230. A preferred pump head and pump for this application is Biomedicus 550 manufactured by Medtronic, which includes a biocompatible surface that transports blood through a cone that is moved by a magnetic field and minimizes hemolysis of the blood. As can be seen from the figure, the centrifugal pump head 230 and the driver 232 comprise both pressure control means for controlling the pressure of the liquid medium and flow control means for controlling the flow of at least a part of the liquid medium.
Centrifugal pump 230 moves blood and preservation solution via pump outlet line 234 to an integrated heat exchanger 210 that warms or cools the preservation solution to a predetermined temperature. Although the donor organ 12 is preferably maintained at a normal body temperature of about 37 ° C., the temperature of the preservation solution can be lowered to a temperature of about 20 ° C. using the integrated heat exchanger 210. This heating and cooling function is performed by a water heater / cooler unit 236 that circulates temperature controlled water through the water side 238 of the heat exchanger 210 via the water circuit line 240. The preservative circulates through the second liquid side 242 of the integrated heat exchanger 210 where it reaches the desired temperature.
The temperature-controlled stock solution then flows through the connection line 244 into the integrated membrane oxygenerator 208. As part of this embodiment, blood in the preservative solution is preferably membrane oxygenator 208 at a rate of 1-5 L / min, using a mixture of 95% -97% O 2 and 3% -5% CO 2. Is enriched by oxygen. This mixture is fed to oxygenator 208 via inlet / outlet line 246. As already mentioned, preferred oxygenerators include hollow fiber oxygenerators such as Monolyth oxygenator manufactured by Sorin Biomedical Co., Ltd. and MINIMAX PLUS manufactured by Medtronic. Although not specifically shown in FIG. 5, the membrane oxygenator 208 is provided with the necessary mixture of oxygen and carbon dioxide from a regulated oxygen bottle 178 (FIG. 4). The oxygenator 208 also includes a plurality of outlets that deliver the pressurized storage solution to other devices. That at least one of the outlets of the oxygenator 208 comprises an integrated temperature monitoring probe (not shown) that can be used to monitor the temperature of the liquid medium exiting the oxygenator. It must be recognized. More specifically, the first outlet line 248 supplies the preservation solution to the arterial filter 252. The filter 252 is preferably a 20 micron arterial filter, such as a Medtronic pediatric arterial filter. The second outlet line 250 serves as a recirculation line and supplies a storage solution to the leukocyte filter 254. The filter 254 is preferably a micron leukocyte filter such as a Pall leukocyte removal filter manufactured by Pole Filters. That is, the filters 252 and 254 comprise filtration means for removing unwanted filtrate from the liquid medium.
The outlet of the arterial filter 252 is connected to the selector valve 50 via a filter outlet line 48. The selector valve 50 allows fluid flow to either the initial perfusion line 52 (for forward perfusion through the aorta), the left atrial supply line 54 (for forward perfusion through the left atrium), or both lines simultaneously (for priming). Is a multi-position stopcock that can be placed in one of several positions to face. Furthermore, the selector valve 50 may be completely deactivated. As already mentioned, the lines 48, 54 and possibly the lines 52 and 58 form the arterial side 16 or delivery means of the storage circuit 202. The end of the initial perfusion line 52 is connected to a tee or Y connector 56 which then branches to an aortic line 58 and a line 60 which is an afterload column. One end of the tee 56 is also equipped with a pressure transducer 256 that allows the pressure of the preservative solution, more specifically the aortic root pressure, to be monitored by the central signal processor and controller 560. A straight connector 258 is provided to connect the height adjustable afterload column line 60 and the aorta return line 62. A luer port 63 having a siphon prevention valve fixed to a stopcock provided above is integrated with the connector 258, so that the liquid pumped across the connector 258 does not further siphon from the rear load line 60. Acts as a one-way valve to allow flow through the aortic return line 62.
The distal end of the afterload line 60 is attached to one of the connectors on the three-way port 260 to allow the preservation solution to be returned to the reservoir 212. As already mentioned, the aortic line 58 provides a bi-directional flow of flow to and from the donor heart 12 depending on which mode the storage system 200 is operating. Also, the height of the afterload column 60 can be adjusted to a range of vertical positions to selectively change the afterload pressure to which the donor heart 12 beats or pumps. The height of the afterload column 60 is adjusted by an electrical mechanism instrument that is feedback adjusted in response to coronary flow and aorta and / or left ventricular pressure signals received by the controller 560. When the preservation solution pumped through the afterload column 60 crosses the stopcock connector 258 and the siphon prevention luer port 63, it is returned to the liquid reservoir 212 via the aorta return line 62 by gravity. A right ventricular return line 64 is also connected between the three-way port 260 of the pulmonary artery 132 and the cannula 122 to return coronary effluent to the liquid reservoir 212. That is, the lines 58, 60, 62 and 64 form the venous side 18 of the storage circuit 202 and provide a means to carry fluid medium out of the heart.
Aortic flow is measured by an ultrasonic flow probe 66 that forms part of the aortic line 58. Similarly, the ultrasonic flow probe 68 measures the coronary blood flow of coronary effluent flowing through the right ventricular return line 64 from the right ventricle to the fluid reservoir 212. Signals generated by the flow probes 66, 68 are sent to respective inlets 66A, 68A on the system controller 560. Alternatively, the aorta and coronary flow signals generated by the ultrasonic flow probes 66 and 68 may have the flow meter shown in FIG. 1 having at least two channels to assist in the monitoring and storage system 200 operating status of the donor heart 12. 70 or a multi-channel data recorder / controller such as flow meter 562 shown in FIG. As already mentioned, the preferred flow meter is a 2-channel flow meter manufactured by Transonic Systems. However, in this aspect, the central controller 560 will monitor all relevant signals from one central station by receiving signals generated by the various transducers as feedback signals. Alternatively, the signals from pressure transducers 72 and 256 may be monitored by a multichannel data recorder and displayed by a laptop computer 564. A preferred device is an integrated hardware / software system such as MacLab (registered trademark) manufactured by ADInstruments, Inc. These feedback signals can then be used to monitor and regulate the pressure and flow supplied by pump 230 via control line 580 and the temperature of heat exchanger 210 via bidirectional control line 582. . The central processor or controller 560 has also been shown to receive a temperature feedback signal 584 from the temperature probe outlet (not shown) of the oxygenator 208.
Coronary flow is maintained within an acceptable physiological range (300-500 ml / min) by adjusting the height of the afterload column 60 above the heart 12 and adjusting the flow rate generated by the pump 230. The The afterload pressure is maintained at about 70 mm mercury but can be adjusted as needed. A microchip pressure catheter 72 is inserted into the left ventricle via the left atrium 134 to measure the intracavity pressure of the donor heart 12. A preferable pressure catheter 72 includes a type manufactured by Miller Instruments. All pressure measurements generated by the pressure catheter 72 are recorded and displayed using a digital pressure recording system 74 such as that manufactured by Maclab, which also assists in monitoring the condition of the preserved organ 12. . As disclosed, the pressure recording system 74 can record and display a number of pressure measurements. On the other hand, the signal generated by the pressure catheter 72 may be stored or received by the central controller 560 online to the display 72A.
As part of the present invention, the controller 560 shall also control a mechanical actuator or arm 566 (FIG. 11) that can automatically adjust the height of the afterload column 60 during storage. This is the flow signal generated by the flow probes 66, 68 and the pressure signal generated by the pressure transducer 256 and pressure catheter 72 received by the controller 560 online at 256A and 72A, respectively, as shown. This is achieved by monitoring.
Alternatively, a pacemaker and internal defibrillator 220 may be connected to the ventricular wall of the conserving heart 12 via a pacing lead 221 to correct unwanted arrhythmias during the preservation period by DC shock.
The second port of the oxygenator 208 supplies oxygen enriched blood to the outlet line 250 that is carried to the leukocyte filter 254. The outlet line 262 of the filter 254 delivers the preservative solution to a hemodialysis filter 264 filter placed in a series of locations in the line 262 between the first stopcock 266 and the second stopcock 268. The hemodialysis filter 264 serves to remove metabolic waste products that may be produced by the preserved organ. Preferred hemodialysis filters 264 for this application include those manufactured by Cobe or Baxter.
The outlet of the stopcock 268 supplies filtered blood to the 2-port dripping manifold 270, which receives the first and second stock solutions from the solution bags 272 and 274, respectively. As shown, the drip manifold 270 includes two stopcock valves that assist in controlling the delivery of the chemical solution of the present invention to the stock solution flowing through the drip manifold 270. The outlet line 276 of the drip manifold 270 is connected to a three-way port 260 for returning the enhanced preservation solution to the liquid reservoir 212. Although not specifically shown, an infusion pump is used to individually control and adjust the dropping rate of the chemical solution contained in the dropping bag 272, 274 to the dropping manifold 270, as is known in the art. It should be recognized that each solution bag 272, 274 is inserted between the drip manifold 270.
Various materials can be used to make the various lines and elements of the storage system 200. Since almost all lines and elements of the storage circuit 202 are always in contact with the storage fluid medium, it is desirable to suppress the acute inflammatory response caused by intravascular fluid exposure to the extracorporeal artificial surface. To solve this problem, all contact surfaces in the perfusion circuit 14 may be coated or bonded with heparin to reduce complement and granulocyte activation. Alternatively, heparin may be introduced directly into the fluid medium circulating through the storage circuit 202 or other biocompatible surfaces may be utilized for the circuit 202. The introduction of heparin helps to minimize blood clotting in the circuit.
Further, the operation of the storage system 200 will be described more specifically with reference to FIG. As described above, the donor heart is collected in either a beating state or a non-beating or stopped state and placed in the storage chamber 206. At this point, the centrifugal pump 230 is moving oxygen enriched and rewarmed blood through line 248. During priming, the selector valve 50 is positioned such that blood passes through the initial perfusion line 52 and the left atrial supply line 54 simultaneously. Once the arterial line 16 of the storage circuit 202 is primed sufficiently to eliminate the presence of bubbles or air pockets, the valve 50 is rotated to a position to supply fluid to the initial perfusion line 52. The aortic line 58 is then connected and secured to the aorta 130 using the aortic cannula 120. This procedure causes blood to flow into the aorta line 58 and immediately perfuse the inactive beating donor heart 12 through the aorta 130.
Alternatively, the stopcock on the connector 258 may be closed to maximize blood flow to the aorta 130. This procedure of forward perfusion through the aorta 130 is carried out for about 10-15 minutes in order to stabilize the donor organ and to ensure device attachment time. Upon installation of the device, the remaining flow line is connected to the donor heart 12. More specifically, the connection between the aorta line 58 and the aorta 130 is completed and checked for leaks, the supply line 54 is connected to the left atrium 134, and the right ventricular return line 64 is connected to the pulmonary artery 132. The The pulmonary vein, upper and lower vena cava are then closed using surgical sutures. During this initial connection protocol, any excess blood flow is trapped in the storage container 206 and returned to the reservoir 212.
At the end of the stabilization phase, the flow to the aorta 130 simultaneously and gradually increases the flow to the left atrium 134 via the left atrial supply line 54 and gradually blocks the flow through the initial perfusion line 52. The valve 50 returns to the normal operating position. The stopcock of connector 258 is then opened, allowing blood to flow through afterload line 60 and return line 62. This procedure then switches the donor heart 12 from inactive to active and blood is pumped by the donor heart 12 through the return line 18 of the storage circuit 202 to ensure pulsed coronary flow delivery.
Blood flow to the donor heart 12 through the artery or delivery line 16 is assisted by a centrifugal pump 230. The flow rate, pressure and temperature are monitored by a controller 560 that adjusts the speed of the pump head 230 to control the pressure and flow rate of the stock solution. The donor heart 12 is pulsed against the afterload pressure created by the vertical position of the afterload column 60 on the storage chamber 20, thereby generating a pulsed coronary flow. Also, oxygen-enriched blood is supplied to the coronary vasculature, and deoxygenated blood coming from the coronary vasculature is pumped from the right ventricle to the pulmonary artery return line 64 and returned to the reservoir 212. At this point, the donor heart 12 can be maintained in a viable beating state during the storage period.
Turning now to FIG. 6, another configuration of the storage system 200 is shown. As can be seen, the storage system 200 shown in FIG. 6 is comprised of many of the elements shown in FIG. The main difference is that it is supplied to. Thus, this configuration can eliminate some of the fluid delivery lines because the donor heart 12 is stored in a beating inactive state.
In this aspect, the storage system 200 includes a similar integrated storage device 204 that includes an integrated storage container 206 and reservoir 212, a hollow fiber membrane oxygenator 208, and an integrated heat exchanger 210. Oxygen generator 208 and heat exchanger 210 are operated in a manner substantially similar to that described above. As already mentioned, the preservative solution stored in reservoir 212 flows through reservoir outlet 222 to be delivered to pulse pump 280 via outlet line 228. The pulse pump 280 is pulse driven by the electrical control unit 282. A preferred pulse pump for this application is either a Heartmate electric assist pump from Thermo Cardio Systems or a Novocar (R) left ventricular assist pump from Baxter Healthcare. Alternatively, there are other pulse pumps that are also designed with lower stringency standards that are compatible with the storage circuit 202 of this embodiment and provide pulsed flow functionality at a lower cost.
That is, the pulse pump 280 generates a pulse flow as opposed to the steady flow generated by the centrifugal pump 230. The flow of the preservative solution through the heat exchanger 210 and the oxygenator 208 is substantially the same as described above. The first outlet line 248 then carries the preservation solution to the arterial filter 252. The outlet of the filter 252 is connected to a stopcock connector 284 having a similar pressure transducer 256 formed as an integral part thereof. The preservation solution then flows through the aortic delivery line 286 and into the aorta 130 via the aortic cannula 120. The pressure of the liquid in the delivery line 286 can be monitored through the pressure transducer 256. This opposite direction preservation fluid delivery method to the aorta 130 perfuses the coronary vasculature with a fluid medium consisting of oxygen-enriched blood and the various chemical enhancers of the present invention. Coronary effluent is then pumped through the pulmonary artery 132 and into the cannula 122. Coronary effluent is then returned to fluid reservoir 212 through pulmonary artery return line 288. It is noted that the various elements, including the recirculation line 250 and the leukocyte filter 254, hemodialysis filter 264, and drip manifold 270 disposed thereon, operate in a substantially similar manner as described above. It has also been shown that the aortic delivery line 286 and the pulmonary return line 288 are each equipped with ultrasonic flow probes 66, 68 (respectively) for measuring the flow rate through the delivery and return line.
As part of the alternative configuration of FIG. 6, the storage container 206 is similarly sized to contain the donor heart 12 and constitutes a liquid reservoir 212 for storing about 500-3000 ml of liquid medium. However, only one polyurethane filter 214 and one silicon antifoam screen 216 are used. As can be seen, this change to the storage circuit 202 is a single line or delivery means for delivering oxygen-enriched blood to the aorta 130 for delivery to the coronary artery using a forward perfusion technique, and the donor heart. 12 allows the use of only one line or means connected to the pulmonary artery to carry coronary effluent (deoxygenated blood) out of twelve. That is, the pulse flow provided by pulse pump 282 eliminates the need for an additional cannula or perfusion line connected to the left atrium. This pulse flow prevents coronary spasm and coronary endothelial injury and provides coronary flow with physiological characteristics for optimizing the microcirculation of preserved organs. By storing the donor heart 12 in a non-pulsating state, it is possible to reduce oxygen consumption and pump stress on the afterload column. This further reduces cellular metabolism and cellular waste, leading to extended shelf life. Alternatively, an intraventricular vent may be placed in the left ventricle to discharge blood leaking from the aortic valve.
As part of the alternative configuration, the storage container 206 is similarly sized to hold the donor heart 12 and constitutes a liquid reservoir 212 for storing about 500-3000 ml of liquid medium. However, there is an internal septum for separating the liquid medium from the storage organ (not shown). In this configuration, the organ is placed on the upper end of the reservoir separated from the liquid medium of the circuit. According to this configuration, the stored organ can be completely visualized during the storage and transportation period.
Although the preservation of the donor heart for transplantation has been described above, it is also within the scope of the present invention that the preservation system 200 can be used to maintain the heart during reconstruction surgery and other types of surgery. It is. That is, according to this procedure, an individual's heart can be extracted, placed in the storage circuit 202 of the present invention, and operated outside the body. In this case, the patient can be temporarily maintained with appropriate bypass and heart / lung machines as is known in the art. However, removing the heart or other organs for corrective surgery and keeping the organs alive makes it easier to perform procedures that would normally be complex and risky for organs outside the body. Can be implemented. When surgery on the organ is complete, the organ is re-implanted into the original patient's body. Another application is to excise and maintain an organ and perfuse the organ with chemotherapy for cancer treatment. After the chemotherapy procedure is complete, the organ can be re-transplanted. This procedure is particularly useful for the treatment of liver, kidney, or pancreatic cancer. That is, the storage system 200 according to the disclosure of the present invention provides various uses other than keeping the transplanted donor organ alive.
7-10, another aspect of a storage system according to the teachings of the present invention will now be disclosed. In view of the description below, the preservation system of the present invention can also be used for transplantation in kidney, liver, lung, pancreas, small intestine, and severe burn or trauma patients, or even cancer patients. It will be appreciated that it can be used to preserve a variety of solid organs, including but not limited to valves (myocutaneous free flaps). The storage system can also be used for the purpose of keeping various blood vessels, such as the aorta, and vein grafts alive for transplantation or plastic and reconstructive surgery. According to this aspect of the invention, the solid organ to be stored or maintained in a living state is enclosed in a soft shell bag specifically designed for the organ. At least one artery and one vein are cannulated so that a preservation solution containing compatible blood is delivered to and removed from the organ. That is, the storage circuitry required for this alternative configuration is similar to that used to store the donor heart as described above.
With particular reference to FIG. 7, a storage system 300 for storing the kidney 310 is shown. The kidney preservation circuit 302 serves to deliver oxygen-enriched liquid to the kidney 310 and carry out degraded liquid from the kidney 310. The kidney storage circuit 302 also utilizes an integrated storage device 204, a heat exchanger 210, and an oxygenator 208 that form a storage container 206 and a liquid reservoir 212. The warmed, oxygen-enriched preservation solution is conveyed from the one port of the oxygenator 208 to the arterial filter 314 via the outlet line 312. An ultrasonic flow probe 316 measures the flow rate through line 312. Line 312 connects to an arterial stopcock connector 318. A pressure transducer 320 is formed at the opposite end of the stopcock connector 318 and also connects to the arterial fitting 322 of the soft shell bag. An arterial cannula 324 is inserted into the arterial fitting 322 and extends into the storage chamber 364 of the soft shell bag 360. The arterial cannula 324 then connects to the renal artery 326 to deliver oxygen enriched preservation solution to the donor kidney 310. Similarly, a return line 328 extends between the upper end cover assembly 22 of the fluid reservoir 212 and the venous stopcock connector 330. An ultrasonic flow probe 356 is also provided along the return line 328 to monitor the return flow of the degraded liquid. The opposite end of the connector 330 also includes a pressure transducer 332 that is used to monitor the pressure of the depleted fluid medium carried out of the donor kidney 310. The pressure transducer 332 connects to a venous fitting 334 that also includes an inserted venous cannula 336. The vein fitting 334 is also preferably formed integrally with the soft shell bag 360. The venous cannula 336 is connected to the renal vein 338 of the donor kidney 310. The ureter 340 of the kidney 310 is connected to a ureter cannula 342 that is also integrated with a ureter connector 348 for carrying urine through line 344 into a calibrated container 346. A stopcock connector 348 is provided along line 344 to stop the flow through line 344 if container 346 has to be changed or if a urine sample has to be taken. Further, the liquid may be discharged from the container 346 through the stopcock 354. The scale of the container 346 allows the urine production of the kidney 310 to be monitored during the storage period.
As in the other related embodiments, the oxygenator 208 includes a second recirculation line 250 that delivers a temperature controlled oxygen-enriched preservative to the leukocyte filter 254 and optionally the hemodialysis filter 264. . The outlet of the filter 264 connects to a similar two-port dripping manifold 270 that receives chemical solutions from the solution bags 272, 274 at various drip rates. The enhanced preservation solution is returned to the reservoir 212 via the return line 276. The dropping rate of the chemical solution is controlled by a suitable infusion pump (not shown) as described above. As can be seen, centrifugal pump 230 or pulse pump 280 can be used to circulate the fluid medium through a circuit for storing any solid organ.
The enclosing means associated with the kidney storage circuit 302 includes a generally rectangular plastic bag 360 that includes a sealed body portion 362 and a storage chamber 364. An antifoam line, a soft shell (not shown), an inner ziplock closure 366, and an outer ziplock closure 368 are provided on the outer periphery of the storage chamber 364. That is, these closures 366, 368 are flaps that can be unzipped and opened on the sealed body portion 362 to ensure that such organs are inserted as described above and properly cannulated. flap) 370 is formed. The closures 366, 368 are then sealed to enclose such organs and form a storage chamber 364. A reinforcing member 384 formed by heat sealing is placed at the end of the closures 366,368. Two ziplock closures 366, in order to enhance structural rigidity and provide a primary and secondary seal to prevent liquid remaining in the storage chamber 364 from causing undesirable liquid leakage 368 are provided (facing each other). A vent assembly 372 is integrated into the body portion 362 and extends below both ziplock closures 366, 368 and into the storage chamber 364. The upper end of the vent 372 includes a stopcock valve 374 that allows air to enter and exit from the storage chamber 364. The storage chamber 364 can also be filled with a biocompatible liquid such as saline or a pharmaceutically active liquid via the vent 372 after the flap 370 is properly sealed.
The kidney storage bag 360 may also be provided with one or more reinforcing ribs 376 that provide additional structural rigidity to the storage bag and further assist in maintaining a certain shape. A hole 378 is provided in each corner of the storage bag 360 where the bag is suspended from the horizontal support member 380 by a pair of bag hangers 382. One advantage of the soft shell bag 360 is that the ultrasound probe can be applied to the organ while being protected by the bag, so that the ultrasound examination can be performed while the kidney 310 remains in the bag 360. There is.
Turning now to FIG. 8, a storage system 300 for storing the liver is shown. The liver preservation circuit 304 serves to deliver the oxygen-enriched liquid medium to the liver 390 and carry the degraded liquid out of the liver 390. The liver storage circuit 304 also utilizes an integrated storage device 204, a heat exchanger 210, and an oxygenator 208 that form a storage container 206 and a liquid reservoir 212. The warmed, oxygen-enriched preservation solution is conveyed from one port of the oxygenator 208 to the arterial filter 314 via the outlet line 312. An ultrasonic flow probe 316 measures the flow rate through line 312 as described above. At this position, the line 312 branches into two lines. One ends with an arterial stopcock connector 392 and the other branch ends with an arterial stopcock connector 394. Each stopcock connector 392, 394 also includes a pressure transducer 396, 398 (respectively) formed at its opposite end. The connector 392 also connects to the arterial fitting 400 that is integrally formed with the soft shell bag. A suitable cannula 402 is inserted into the arterial fitting 400 and extends into the storage chamber 444 of the soft shell liver bag 440. The cannula 402 then connects to the portal vein 404 for delivering oxygen-enriched stock solution to the donor liver 390. An arterial stopcock connector 394 is also connected to the arterial fitting 400 of the soft shell bag. An arterial cannula 408 is inserted into the arterial fitting 406 and extends into the storage chamber 444 of the soft shell bag 440. The arterial cannula 408 then connects to the bifurcated hepatic artery 410 to deliver oxygen enriched preservation solution to the left and right lobes of the donor liver 390. Similarly, the return line 412 is between the upper end cover assembly 22 of the liquid reservoir 212 and a return stopcock connector 414 that in turn connects to a return fitting 416 that is also integrally formed in the soft shell bag 440. It is growing.
As shown, the inferior vena cava 418 is open and left uncannulated so that the depleted stock can flow directly into the storage chamber 444 therefrom. That is, the return fitting 416 provides an outlet so that the deteriorated liquid can enter and exit from the return line 412. An ultrasonic flow probe 420 for monitoring the return flow of the deteriorated liquid is provided along the return line 412. The gallbladder 422 still attached to the liver 390 is connected to a suitable gallbladder cannula 424 that also has a fitting 426 inserted therein. Connected to the fitting 426 is a stopcock connector 428 for regulating the flow of bile into the calibrated container 346 through line 430. Stopcock connector 428 also stops flow through line 430 if container 346 has to be changed or for bile sampling. Further, the liquid may be discharged from the container 346 through the stopcock 354. The scale of the container 346 allows the bile production of the gallbladder 422 to be monitored during the storage period.
As in the other related embodiments, the oxygenator 208 includes a second recirculation line 250 that delivers a temperature controlled oxygen-enriched preservative to the leukocyte filter 254 and optionally the hemodialysis filter 264. . The outlet of the filter 264 connects to a similar two-port dripping manifold 270 that receives chemical solutions from the solution bags 272, 274 at various drip rates. The enhanced preservation solution is then returned to the reservoir 212 via the return line 276. The dropping rate of the chemical solution is controlled by a suitable infusion pump (not shown) as described above.
The encapsulation means associated with the liver storage circuit 304 also includes a generally rectangular plastic bag 440 that includes a sealed body portion 442 and a storage chamber 444. It is noted that the liver bag 440 shares many of the same elements as the kidney bag 360 described below.
An inner ziplock closure 366 and an outer ziplock closure 368 are provided on the outer periphery of the storage chamber 444. That is, these closures 366, 368 are flaps 370 that can be unzipped and opened with respect to the sealed body portion 362 in order for such organs to be inserted as described above and properly cannulated. Is forming. The closures 366, 368 are then sealed to enclose such organs and form a storage chamber 364. A reinforcing member 384 formed by heat sealing is placed at the end of the closures 366,368. Two ziplock closures 366, in order to enhance structural rigidity and provide a primary and secondary seal to prevent liquid remaining in the storage chamber 364 from causing undesirable liquid leakage 368 are provided (facing each other). A pair of vent assemblies 372 are integrated into the body portion 362 and extend into the storage chamber 444 below both ziplock closures 366, 368. The upper end of each vent 372 includes a stopcock valve 374 that allows air to enter and exit from the storage chamber 444. The storage chamber 444 can also be filled with a biocompatible or pharmaceutically active liquid through the vent 372 after the flap 370 is properly sealed.
The liver storage bag 440 may also be provided with one or more reinforcing ribs 376 that provide additional structural rigidity to the storage bag and further assist in maintaining a certain shape. In addition, a hole 378 is provided in each corner of the storage bag 440 where the bag is suspended from the horizontal support member 380 by a pair of bag hangers 382.
Turning now to FIG. 9, a storage system 300 for storing the pancreas 450 is shown. The pancreas preservation circuit 306 also serves to deliver the oxygen-enriched fluid medium to the pancreas 450 and carry the degraded fluid out of the pancreas 450. As shown, pancreas 450 is harvested along with duodenum 452. The pancreas storage circuit 306 also utilizes the integrated storage device 204. The warmed, oxygen-enriched liquid medium is conveyed from one port of the oxygenator 208 to the arterial filter 314 via the outlet line 312. An ultrasonic flow probe 316 measures the flow rate through the arterial line 312. Line 312 connects to an arterial stopcock connector 454. A pressure transducer 456 is formed at the opposite end of the stopcock connector 454 and connects to an arterial fitting 458 that is integrally formed with the soft shell bag. An arterial cannula 460 is inserted into the arterial fitting 458 and extends into the storage chamber 494 of the soft shell bag 490. Arterial cannula 460 then connects to pancreatic / duodenal artery 462 to deliver oxygen-enriched preservation solution to pancreas 450. Similarly, a return line 464 extends between the upper end cover assembly 22 of the fluid reservoir 212 and the venous stopcock connector 466. An ultrasonic flow probe 465 is provided along the return line 464. The opposite end of the connector 466 also includes a pressure transducer 468 that is used to monitor the pressure of the depleted fluid medium carried out of the pancreas 450. The pressure transducer 468 connects to a venous fitting 470 that also includes a venous cannula 472 inserted therein. The vein fitting 470 is also preferably formed integrally in the soft shell bag 490. Arterial cannula 472 connects to the splenic vein and / or portal vein of pancreas 450. The pancreatic duct 476 of the pancreas 450 is connected to an appropriately sized cannula 478 that is also inserted into an integrated cannula fitting 480 for carrying pancreatic juice through line 344 into a similar graduated container 346. As described above, a stopcock connector 482 is provided along line 344 to stop flow through line 344 when the container 346 must be changed. Further, the liquid may be discharged from the container 346 through the stopcock 354. The scale of container 346 allows pancreatic juice production in pancreas 450 to be monitored during storage.
As in the other related embodiments, the oxygenator 208 includes a second recirculation line 250 that delivers a temperature controlled oxygen-enriched preservative to the leukocyte filter 254 and optionally the hemodialysis filter 264. . The outlet of the filter 264 also connects to a two-port dripping manifold 270 that receives chemical solutions from the solution bags 272, 274 at various drip rates. The enhancement liquid medium is returned to the reservoir 212 via the return line 276. The dropping speed of the chemical solution is similarly controlled by a suitable infusion pump (not shown) as described above.
The encapsulating means associated with the pancreas storage circuit 306 includes a generally rectangular plastic bag 490 that includes a sealed body portion 492 and a storage chamber 494. An inner ziplock closure 366 and an outer ziplock closure 368 are provided on the outer periphery of the storage chamber 494. That is, these closures 366, 368 form a flap 370 that can be unzipped and released from the body portion 362 to allow such organs to be inserted and properly cannulated as described above. ing. As shown, one corner of the flap 370 is unzipped to illustrate its operation. The closures 366, 368 are then sealed to enclose such organs and form a storage chamber 494. A reinforcing member 384 formed by heat sealing is placed at the end of the closures 366,368. Two ziplock closures 366, to enhance structural rigidity and to provide a primary and secondary seal to prevent liquid remaining in the storage chamber 494 from causing undesirable liquid leakage 368 are provided (facing each other). One feature of the pancreatic bag 490 is a sloped portion 484 that serves to collect remaining liquid in the bottom of the storage chamber 494. A vent assembly 372 is integrated into the body portion 492 and extends into the storage chamber 494 below both ziplock closures 366, 368. The upper end vent 372 includes a stopcock valve 374 that allows air to enter and exit from the storage chamber 494. The storage chamber 494 also seals the flap 370 correctly, and then a biocompatible liquid such as physiological saline, or a pharmaceutically active liquid (contacts or baths outside the organ) via the vent 372. To meet). The pancreas storage bag 490 can also be provided with one or more reinforcing ribs 376 that provide additional structural rigidity to the storage bag (suspended) and further assist in maintaining a certain shape. A hole 378 is provided in each corner of the storage bag 490 that suspends the bag from the horizontal support member 380 by a pair of bag hangers 382. One advantage of the soft shell bag 490 is that the ultrasound probe can be applied to the organ while it is protected by the plastic wall of the bag, so that the ultrasound stored in the organ stored therein is performed. There are times when you can. It is also noted that the small intestine can be preserved in a manner similar to that of the disclosed pancreas.
Referring to FIG. 10, a storage system 300 for storing one or two lungs 500 is shown. Lung preservation circuit 308 also serves to deliver the oxygen-enriched liquid medium to lung 500 and carry the degraded liquid out of lung 500. The lung storage circuit 308 also utilizes the integrated storage device 204 as indicated above. The warmed, oxygen-enriched stock solution medium is conveyed from the one port of the oxygenator 208 to the arterial filter 314 via the outlet line 312. An ultrasonic flow probe 316 measures the flow rate through line 312. Line 312 connects to an arterial stopcock connector 508. A pressure transducer 510 is formed at the opposite end of the stopcock connector 508 and connects to an arterial fitting 512, which is preferably molded or integrated with a soft shell bag. An arterial cannula 514 is inserted into the arterial fitting 512 and extends into the storage chamber 534 of the soft shell bag 530. It then has an arterial cannula 514 connected to the pulmonary artery 516 and then bifurcated into each lung to deliver the oxygen-enriched preservation medium to the lung 500. Similar to the above, a pair of return lines 518 extend between the upper end cover assembly 22 of the liquid reservoir 212 and the pair of stopcock connectors 520. As shown, each stopcock connector 520 is integrally formed with the soft shell bag 530 and is placed in fluid communication with a collection portion 522 formed in the storage chamber 534. An ultrasonic flow probe 524 is provided along each return line 518 to monitor the return flow of the degraded liquid. Although not specifically shown, the pulmonary veins of the lung 500 are not cannulated, but rather are drained directly into the storage chamber 534. As shown specifically, the lower portion of the storage chamber 534 includes an arcuate surface 526 to facilitate the flow of degraded liquid to the collection portion 522.
As in the other related embodiments, the oxygenator 208 includes a second recirculation line 250 that delivers a temperature controlled oxygen-enriched preservative to the leukocyte filter 254 and optionally the hemodialysis filter 264. . The outlet of the filter 264 connects to a similar two-port dripping manifold 270 that receives the chemical solution from the solution bags 272, 274 at a predetermined drip rate. The enhanced stock solution medium is then returned to reservoir 212 via return line 276. The dropping rate of the chemical solution is also controlled by a suitable infusion pump (not shown) as described above.
The enclosing means associated with the lung storage circuit 308 also includes a generally rectangular plastic bag 530 that includes a sealed body portion 532 and a storage chamber 534. An inner ziplock closure 366 and an outer ziplock closure 368 are provided on the outer periphery of the storage chamber 534. That is, these closures 366, 368 also have a flap 370 that can be unzipped and opened with respect to the sealed body portion 532 to ensure that the lungs are inserted as described above and properly cannulated. Forming. The closures 366, 368 are then sealed to enter the lungs and form the storage chamber 534. A reinforcing member 384 formed by heat sealing is placed at the end of the closures 366,368. Two ziplock closures 366, 368 to enhance structural rigidity and to provide a primary and secondary seal to prevent residual liquid in storage chamber 534 from causing undesirable liquid leakage. Are provided (facing each other). A pair of vent assemblies 372 are integrated into the body portion 532 and extend below both ziplock closures 366, 368 and into the storage chamber 534. The upper end of each vent 372 includes a stopcock valve 374 that allows bidirectional liquid exchange with the storage chamber 534. As shown, the trachea 502 is connected to a ventilation tube and cannula 504 that are also integrally formed with the lung storage bag 530. Volumetric air is supplied to the ventilation line 504 by a suitable ventilation machine 506. Since the lungs must be periodically ventilated by an appropriate ventilation machine 506 to prevent such lung alveoli from collapsing, the volume defined by the storage chamber 534 is reduced to the corresponding expansion and contraction of the lungs 500. It is necessary to expand and contract to match. That is, the open vent 372 allows air to enter and exit the storage chamber 534. This expansion and contraction can be done by any means for breathing the lungs.
The lung storage bag 530 can also be provided with one or more reinforcing ribs 376 that function substantially as described above. A hole 378 is provided in each corner of the storage bag 530 where the bag is suspended from the horizontal support member by a pair of bag hangers 382. Although this feature is not specifically shown, it is assumed that the bag hanger 382 functions as shown in FIGS.
Turning now to FIG. 11, a mobile storage system 540 according to a preferred embodiment of the present invention is shown. More specifically, the mobile storage system 540 includes a body 542 having four locking casters 544. One side of the mobile storage system 540 includes a storage area 546 for storing elements of the storage circuit 202. A cover 548 is provided to protect the storage circuit 202 during transportation. The other side of the mobile storage system 540 includes an electronics portion 550. As shown, the electronics portion 550 includes a power source 552 having a battery and an uninterruptible power supply (UPS) 554, and a power converter 556. As shown, a pump controller 558 is installed adjacent to the power supply 552, which can be either the controller of the centrifugal pump 232 or the controller unit 282 of the pulse pump 280. The heating / cooling control unit 236 is preferably located at the upper end of the power source 552 and the pump controller 558. It has also been shown that the water circulation line 240 extends between the heat exchanger 210 and the water heater / cooler unit 236. A regulated oxygen tank 178 is fixed in the storage area 546. A system processor / controller 560 is provided at the upper end of the water heater / cooler unit 236. Finally, a two-channel flow meter 562 is integrated into the upper end of the electronics portion 550. Also shown is a notebook computer 564 that can be fixed or integrated into the upper end of the mobile storage system 540. The display of the personal computer 564 is shown with various pressure and flow signals received from the system controller 560 displayed. The system controller 560 is a data logger (Figure) for digital storage of all data (flow, pressure, oxygen saturation, volume, and electrocardiogram (EKG) activity) recorded during storage, transport, evaluation, or resuscitation. (Not shown).
Elements within the electronics portion 550 also include various displays for monitoring the operation of the mobile storage system 540. More specifically, the water heater / cooler unit 236 has a temperature display 586. Central processor / controller 560 is shown to include three displays 588 for preferably displaying any data received and / or processed by central controller 560. Finally, the flow meter 562 is shown to include two displays 590 for displaying the flow rate of the storage liquid medium flowing through the storage circuit 202. It has also been shown that the mechanical control arm 566 exits the system controller 560 and is operated.
One feature of the mobile storage system 540 is that it has a hinge arm 570 that is pivotally connected to a pivot bracket 568. A rod or pole 572 extends vertically from the outer end of arm 570. The pole 572 can have various support brackets clamped thereto. More specifically, the clamp bracket 574 supports the pump driver 232. The clamp bracket 576 includes a semicircular member 578 for supporting the integrated storage container 204. Finally, a horizontal support member 380 is provided so that the solution bags 272 and 274 are suspended therefrom.
It should be particularly noted that the mobile storage system 540 shown in FIG. 11 does not necessarily have to draw a scale drawing, but includes a representative storage circuit 202 incorporated therein. That is, those skilled in the art will recognize that any of the storage circuits disclosed herein can be configured within the storage area 546 and connected to the electronics portion 550. Although not specifically shown, it should also be understood that the signals generated by pressure transducers 72, 256 and flow probes 66, 68 are connected to processor / controller 560 and flow meter 562. The controller 560 also receives various signals from an integrated online hematocrit and oxygen saturation sensor, such as those manufactured by Medtronic. Also, soft shell storage bags 360, 440, 490, 530 for storing or maintaining any solid organ may also be configured and suspended within the storage area 546.
Assume that the electrical elements enclosed in the mobile display system 540 are powered by a dedicated power source 552. As disclosed, the power supply 552 provides general purpose 110 / 220V AC power at the appropriate 60/50 Hz level depending on the electronic device encapsulated therein. The power supply 552 can accept DC power in the range of 12-24 volts through the receptacle, as well as 110 / 220V AC power at 60/50 Hz. That is, the power supply 552 also includes a bidirectional DC / AC power converter 556 that can receive power from land transportation means such as ambulances and various power supplies found in aircraft such as airplanes and helicopters. Furthermore, the power source 552 shall also include several types of storage energy devices in the form of UPS 554 for delivering the required level of power to the mobile storage system when external power is not available.
Turning now to FIG. 12, various methods associated with storage systems 200 and 300 are summarized. Upon reviewing the following description, one of ordinary skill in the art will readily appreciate that the steps that make up the disclosed method are based on various representative aspects of the invention. In short, donor organs such as donor heart 12 are collected at block 600. The donor organ is then connected to a storage circuit, such as storage circuit 200, and placed in storage container 206 as indicated by block 602. At block 604, the preservation medium of the present invention is delivered to at least one large blood vessel, preferably an artery of the donor organ. At block 606, the degraded preservation medium is carried out of the donor organ. At block 608, the temperature of the fluid medium and / or donor organ is maintained at a substantially normal body temperature between about 20 ° C and about 37 ° C. At block 610, at least a portion of the preservative liquid medium is oxygen enriched by the oxygenator 208. At block 612, the preservation liquid medium is filtered as described above. At block 614, the flow rate and / or pressure of the preservative liquid medium can be measured and monitored, such as by the central controller 560, the flow meter 562, and the like. At block 616, a preservative liquid medium may optionally be delivered outside the donor organ to supply a chemical solution in bath or liquid medium to the outside of the organ. Finally, return line 618 may continue the shelf life for up to 24 hours or more by repeating the method and continuing delivery of the preservation fluid to the large blood vessels of the donor organ at block 604. It can be so.
The liquid medium of the present invention includes whole blood and a preservation solution. As noted above, some of the compositions, methods and systems / devices of the present invention utilize whole blood that is compatible with the stored organ or organs. Basic and clinical trials have shown that donors or donor-compatible blood perfusates provide more suitable substrates, oxygen delivery, endogenous free radical scavengers, high-titer buffers, and improved colloid osmotic pressure. It has been shown to be more suitable as an alternative to donor heart preservation. It is also possible to optionally use whole blood from which certain elements or components that may have adverse effects over time in one or more preserved organs have already been removed. For example, in one embodiment, whole blood is processed to obtain leukocyte-removed blood by passing it through a leukocyte removal filter prior to use in the present invention. Since one of the objectives of the present invention is to provide an environment that is closest to the donor, the higher the compatibility of whole blood, the more likely it will be stored successfully.
To form a liquid composition (sometimes referred to herein as a liquid or liquid medium), whole blood is mixed with a stock solution. Such liquid may be supplied at any time prior to delivery to one or more particular main containers and / or outside the organ such that the liquid or liquid medium is supplied to the container and soaks or substantially surrounds the organ. And may be formed by mixing whole blood with elements of a preservation solution. The components of the preservation solution can be mixed with whole blood alone or in combination. For example, in one preferred embodiment, a storage stable stock solution premix is formed by mixing carbohydrate, sodium chloride, potassium, calcium, magnesium, bicarbonate ion, epinephrine, and adenosine prior to forming the liquid medium. Let The final fluid medium is then formed by mixing whole blood, the premix, and other desirable liquid components that are not storage stable in the premix, such as insulin, immediately prior to delivery to the organ.
The liquid and / or organ preservation solutions herein utilize effective amounts of carbohydrates, electrolytes, hormones, and other pharmaceutically active or beneficial agents conventionally available for intravenous or direct injection delivery. . As used herein, the term “effective amount” refers to an amount sufficient to beneficially affect one or more organs being stored. Such beneficial effects include, but are not limited to, organ function, organ viability, implantability, maintenance of transplantability, or any increase or improvement of any of the above. In one highly preferred embodiment, for transplantation 24 hours after the organ has been removed from the donor, more preferably 36 hours after removal, more preferably 48 hours after removal, and even more preferably 72 hours after removal. Use an effective amount that maintains sufficient viability to withstand.
Examples of components that can be used in the liquid medium and / or preservation solution of the present invention include carbohydrates (glucose, dextrose); electrolytes (sodium, potassium, bicarbonate, calcium, magnesium); antibiotics and antimicrobial agents (Gram negative and Gram positive bacteria, eg 250,000-1,000,000 units, preferably 250,000 units of penicillin); hormones (insulin, epinephrine); endogenous metabolites or precursors of endogenous metabolites (Adenosine, L-arginine); fatty acids (saturated and unsaturated, single chain and long chain); and conventional pharmaceutically active agents (heparin, nitroglycerin, ACE inhibitors, beta blockers, calcium channel blockers, cytoprotection) Agent, antioxidant, complement, anti-complement, immunosuppressant, non-steroidal anti Inflammatory agents, antifungal agents, antiviral agents, steroids, vitamins, enzymes, coenzymes, etc.); and other conventional intravenous in assisting solution delivery, bioavailability, or stability Examples include, but are not limited to, substances used for administration or direct injection. Other components such as adjusting the pH, stabilizing the solution, adjusting the viscosity, etc. can also be used (as will be appreciated by those skilled in the art).
The following table lists various more detailed components that can be used alone or in combination in liquid and / or organ preservation solutions at one or more of the aforementioned concentrations. Note that the indicated concentration is a preferred concentration, and the concentration indicated by P = is at least one highly preferred concentration.
According to the present invention, an organ can be preserved at a normal body temperature and in a normal or almost normal functional state. Preferably used substantially free of drugs used in hypothermic cold preservation solutions.
In preferred embodiments, the preservative solution and / or liquid medium is from about 7.35 to about 8.5, more preferably from about 7.4 to about 7.6, and even more preferably from about 7.4 to about 7.5. Maintained at pH.
The compositions, methods, and systems / devices of the present invention are particularly useful in that they can preserve organs for extended periods of time in normal or near normal functional conditions. They can achieve this at normal body temperature or substantially normal body temperature. As used herein, normal body temperature or substantially normal body temperature preferably refers to a temperature range of about 20 ° C to about 37 ° C, more preferably about 25 ° C to about 37 ° C. Normal body temperature that does not fall within the scope of organ transplantation technology usually refers to about 37 ° C., but in organ preservation technology, the term hypothermia usually refers to less than 20 ° C., more typically less than about 4 ° C. Thus, those skilled in the art will understand that normal body temperature or substantially normal body temperature has a somewhat different meaning when applied to organs stored for transplantation.
In addition to the significant advantage of being able to preserve organs under favorable conditions for a significantly longer period of time, another important advantage of the present invention is that the organ can be preserved in a functional state, so In addition, the ability to examine and evaluate organs is much easier and complete. For example, the following tests can be performed on preserved organs to evaluate the viability and function before transplantation.
Heart: Continuous EKG measurements to assess heart rate, rhythm, and viability of such organ conduction systems; echocardiogram measurements to assess wall motion, valve competence, and myocardial function (such as ejection fraction EF); Measurement of pressure, cardiac output, and coronary flow; metabolic assessment by calculating oxygen supply, oxygen consumption, and oxygen demand; blood biochemical indicators (electrolytes, etc.), creatinine phosphokinase (CPK), Complete blood count (CBC) measurement; and assessment of myocardial function for inotropic and metabolic enhancers.
Kidney: Continuous measurement of renal urine output; measurement of urinary sodium excretion as an evaluation of kidney function; measurement of urine osmotic pressure to assess renal concentration function; serum and urine blood urea nitrogen ( BUN) and creatinine 3 measurements, ultrasound analysis to assess the structural integrity of the kidney; metabolic assessment of preserved organs by calculating oxygen supply, oxygen consumption, and oxygen demand; and blood biochemistry Measurement of clinical indicators (electrolytes, etc.), complete blood count (CBC).
Liver: Continuous measurement of bile production (indicator of hepatocyte viability); measurement of hematological test (LFT) of liver function (AST, ALT, alkaline phosphate, albumin, bilirubin (direct and indirect)); in blood Measurement of fibrinogen levels (an indicator of hepatocyte clotting factor production capacity); liver ultrasound analysis to assess hepatic parenchymal cells, intrahepatic and extrahepatic bile trees; and oxygen supply, oxygen consumption, and Assessment of liver metabolism by calculating oxygen demand.
Pancreas: continuous measurement and chemical analysis of pancreatic fluid volume; measurement of serum amylase and lipase values to assess pancreatic viability; ultrasound analysis to assess structural organization and pancreatic duct integrity, diameter, and tolerance; pancreas Measurement of serum insulin levels and glucose to assess endocrine function of the pancreas; and assessment of pancreatic metabolism by calculating oxygen supply, oxygen consumption, and oxygen demand.
Small intestine: Gross observation of intestinal peristalsis, a measure of living intestinal muscle and nerve conduction; macroscopic observation of intestinal color to assess intestinal blood supply and viability; oxygen supply, oxygen consumption, and oxygen Metabolic assessment by calculating required amount; and measurement of blood biochemical indicators (electrolytes, etc.), whole blood count (CBC).
By using the composition, method and system / apparatus of the present invention, an organ can be excised and processed in a functional state. For example, a cytotoxic therapeutic agent or vector such as an antineoplastic agent can be delivered to an organ in an isolated state. Also, other treatment protocols recognized by those skilled in the art, such as gene therapy, may be applied to the organ prior to transplantation. Further, the collected cadaver organ may be resuscitated (usually within 10 to 60 minutes after death), and the viability of the organ may be analyzed, for example, by the above method.
The above description discloses and describes specific embodiments of the present invention. Those skilled in the art will readily recognize from the above description and the accompanying drawings and claims that various changes, modifications and variations can be made without departing from the spirit and scope of the invention as defined in the claims. Will do.
[1] (a) (i) Organ-compatible whole blood or leukocyte-removed whole blood and (ii) an enclosing means for containing the organ that interacts with a liquid medium containing a preservation solution;
(B) delivery means for delivering the fluid medium to at least one large blood vessel of the organ;
(C) means for carrying the liquid medium out of the organ;
(D) temperature control means for maintaining the temperature of the organ at a normal body temperature of about 20 ° C to about 37 ° C;
(E) pressure control means for controlling the pressure of the liquid medium;
(F) oxygen enrichment means for enriching at least a portion of the liquid medium;
(G) filtration means for removing unwanted filtrate from the liquid medium;
(H) flow control means for controlling the flow of at least a portion of the liquid medium; and (i) from mannitol, dextrose, sodium chloride, potassium chloride, insulin, calcium chloride, sodium bicarbonate, monocarboxylic fatty acid and epinephrine. Means for supplying a chemical substance selected from the group consisting of:
A system for storing human harvested organs or human compatible harvested organs that needs to be preserved, revived or evaluated during the pre-transplant preservation period.
[2] The system according to [1], wherein the liquid medium surrounds the outside of the organ.
[3] The system according to [1], wherein the system further includes a separator for separating the liquid medium from the organ.
[4] The system according to [1], wherein the liquid medium delivery means includes a centrifugal pump.
[5] The system according to [1], wherein the liquid medium delivery means includes a pulse pump.
[6] The system according to [1], wherein the oxygen-enriching means includes a membrane oxygenator.
[7] The system according to [1], wherein the system further includes mobile energy storage and supply means.
[8] The system according to [7], wherein the system is independent and mobile in itself.
[9] The system according to [1], further including a rechargeable power source for supplying power to the system.
[10] The system according to [1], wherein the collected organ is selected from the group consisting of a heart, a kidney, a liver, a pancreas, a lung, a small intestine, a blood carrying tube, and a muscle free flap.
[11] The system according to [10], wherein the organ is maintained in a functional state during the storage period.
[12] The system according to [10], wherein the organ is a heart.
[13] The system according to [11], wherein the heart is maintained in a beating state.
[14] The enclosing means further includes (a) a filtering material for removing a specific substance from the liquid medium; and (b) an antifoaming screen for removing bubbles from the recirculating liquid medium,
The system according to [1], including:
[15] The system according to [1], wherein the sealing means is a soft shell bag.
[16] The soft shell bag is
(A) at least one arterial fitting;
(B) at least one vein fitting;
(C) inner ziplock closure;
(D) an outer ziplock closure;
(E) a vent assembly extending from an inner region of the soft shell bag containing the organ to the outside of the soft shell bag; and (f) means for holding the soft shell bag on a fixed support structure;
The system according to [15], which includes:
[17] (1) Metabolic carbohydrates;
(7) epinephrine; and (8) adenosine;
Of a human or human compatible harvested organ in a functional state, which is substantially free of non-metabolic imperme and further has a pH of about 7.4 to about 8.5. Organ preservation solution for preservation.
[18] The solution further comprises heparin, nitroglycerin, ACE inhibitor, beta blocker, calcium channel blocker, cytoprotective agent, antioxidant agent, antifungal agent, antiviral agent, antibacterial agent, immunosuppressive agent, non-steroid [17] The solution according to [17], comprising a pharmaceutically active agent selected from the group consisting of a system anti-inflammatory agent, a steroid, vitamins and a mixture thereof.
[19] The solution according to [18], wherein the liquid further contains insulin.
[20] The solution according to [18], wherein the solution further contains a complement neutralizing agent.
[21] The solution according to [18], wherein the metabolic carbohydrate is selected from the group consisting of dextrose, glucose, and a mixture thereof.
[22] The solution according to [18], wherein the solution further contains at least one fatty acid.
[23] (a) providing an organ in need of storage;
(C) (i) the organ-compatible whole blood or leukocyte-free whole blood; and
(f) Bicarbonate; epinephrine; and insulin
Providing a preservative solution medium comprising:
(D) delivering the fluid medium to at least one large blood vessel of the encapsulated functional organ while the organ is maintained at a normal body temperature of about 20 ° C. to about 37 ° C .;
A method for preserving a human harvested organ or a human compatible harvested organ in a functional state during a preservation period before transplantation.
[24] The method according to [23], wherein the medium contains heparin.
[25] The medium further includes nitroglycerin, ACE inhibitor, beta blocker, calcium channel blocker, cytoprotective agent, antioxidant, antifungal agent, antiviral agent, antibacterial agent, immunosuppressive agent, non-steroidal anti-steroid The method of [23], comprising a pharmaceutically active agent selected from the group consisting of inflammatory agents, steroids, and mixtures thereof.
[26] The method according to [23], wherein the medium further contains at least one fatty acid.
[27] The method according to [26], wherein the method further comprises a step of delivering the liquid medium to the outside of the organ.
[28] The method according to [23], wherein the method includes a further step of filtering the liquid medium when metabolites derived from the organ accumulate in the liquid medium.
[29] The method according to [23], wherein the method further comprises oxygen enriching at least a part of the liquid medium.
[30] The method according to [23], wherein the method further includes a step of measuring a flow rate of the liquid medium.
[31] The method according to [23], wherein the method further includes a step of measuring a pressure of the liquid medium.
[32] The method according to [23], wherein the collected organ is selected from the group consisting of heart, kidney, liver, lung, pancreas, small intestine, blood carrying tube, and muscle free flap.
[33] The method of [32], wherein the organ to be stored is a heart.
A chamber assembly for containing the liver,
Perfusion circuit comprising a second conduit for carry away the liquid that has degraded from the first conduit and liver for providing portal vein and hepatic artery oxygen-enriched liquid of the liver,
A reservoir for containing a portion of liquid disposed along the perfusion circuit, wherein the reservoir includes an inlet for receiving liquid from the perfusion circuit and an outlet for supplying liquid to the perfusion circuit;
A pump for circulating liquid through the perfusion circuit,
Temperature control with an oxygen-enriched device placed along the perfusion circuit to maintain the liver at physiological levels of oxygen enrichment, and a temperature controller sufficient to maintain the heater and fluid at physiological temperatures Device , wherein the physiological temperature is between 20 ° C. and 37 ° C.,
A storage system, wherein the pump, the oxygen enrichment device, and the temperature control device are adapted to operate with a perfusion circuit to maintain the liver in a functional and viable state in an ex vivo environment.
The system of claim 1, comprising a housing for integrating at least a portion of the chamber and perfusion circuit into the mobile assembly.
The system of claim 1, wherein the liquid comprises a blood product.
The system of claim 1, comprising a mobile power source for the system.
The system of claim 1, comprising at least one probe for measuring a liquid flow rate.
The system of claim 5, comprising at least one probe for measuring the flow rate of fluid to the liver.
The system of claim 1, wherein the chamber assembly includes a soft portion.
The system of claim 1, wherein the chamber assembly is substantially transparent.
The system of claim 1, wherein the chamber assembly is a soft shell bag.
The system of claim 9, wherein the soft shell bag includes a sealed body portion and a storage chamber.
The system of claim 1, comprising a selector valve for providing a selective flow path to the liver.
The system of claim 1, comprising a filter.
The system of claim 1, wherein the chamber assembly includes a surface that mates with a corresponding structure in the system during operation.
The system of claim 13, wherein the interlocking is removable and reversible.
A system further comprising a liver physiological condition monitor, wherein the pump, the temperature control device, the oxygen enriched device and the monitor are configured to maintain the liver in a functional and viable state in an ex vivo environment; The system of claim 1, wherein the system is adapted to operate with a perfusion circuit.
The system of claim 15, wherein the monitor is a bile production monitor.
The system of claim 15, wherein the monitor is an ultrasound monitor.
The system of claim 15, wherein the monitor measures liver function blood test values.
The monitor measures the blood fibrinogen value, the system of claim 15, wherein.
The monitor performs metabolic assessment of the liver system of claim 15, wherein.
The system of claim 1, wherein the first conduit is an arterial fitting integrally formed with a chamber assembly.
Arterial fitting, and extends into the switch Yanba assembly is connected to the hepatic artery, claim 21 system description.
The system of claim 1, wherein the gallbladder remains attached to the liver.
24. The system of claim 23 , wherein the gallbladder is coupled to a cannula, the cannula providing bile flow from the gallbladder to the container.
25. The system of claim 24 , wherein bile is monitored by a scale in the container.
A container configured to hold the liver,
An oxygenator configured to oxygen enrich the perfusate,
A perfusion circuit in communication with the oxygenator, wherein the perfusion circuit is
A first line configured to deliver perfusate from the oxygenator to the liver portal;
A second line configured to deliver perfusate from the oxygenator to the hepatic artery of the liver, and an outlet line configured to carry perfusate from the container;
A heater coupled to the perfusion circuit and configured to heat the perfusate to a normal body temperature , wherein the normal body temperature is between 20 ° C. and 37 ° C .;
A pump configured to circulate perfusate through the perfusion circuit and the liver,
A liquid reservoir coupled to the perfusion circuit and configured to contain a portion of the perfusate,
A sensor configured to measure a parameter of the perfusate in the perfusion circuit,
A processor configured to receive the parameter, wherein the processor is in communication with at least one of the oxygenator, the heater, the pump, and the sensor, and a display coupled to the processor save system for a screen, to keep the error Kisobibo liver functional state and a viable state.
27. The system of claim 26 , wherein the system is configured to maintain the liver at a normal body temperature of about 25 <0> C to about 37 <0> C.
27. The system of claim 26 , wherein the system is configured to maintain the liver at a normal body temperature of about 37 degrees Celsius.
27. The system of claim 26 , wherein the perfusate comprises at least one salt.
27. The system of claim 26 , wherein the pump comprises a centrifugal pump.
27. The system of claim 26 , wherein the sensor is configured to measure a flow rate of perfusate in the perfusion circuit.
27. The system of claim 26 , wherein the sensor is configured to measure an oxygen level of perfusate in the perfusion circuit.
A system further comprising a mobile cart, wherein the system is configured to be disposed on the mobile cart to move the system from the first position to the second position. Item 27. The system according to Item 26 .
27. The system of claim 26 , wherein the oxygenator comprises a membrane oxygenator.
27. The system of claim 26 , wherein at least one valve is disposed in the perfusion circuit.
27. The system of claim 26 , further comprising a power source having a battery for operating the system.
27. The system of claim 26 , wherein the display screen is configured to display at least one parameter measured by the sensor.
27. The system of claim 26 , further comprising a container for collecting bile.
Placing the liver in a container;
Enriching the perfusate with oxygen,
Pumping perfusate in a perfusion circuit connected to the liver;
Providing a perfusate to the portal vein of the liver using a perfusion circuit;
Providing perfusate to the hepatic artery of the liver using a perfusion circuit;
Receiving perfusate from the liver;
Heating the perfusate to a temperature of normal body temperature , wherein the temperature of the normal body temperature is 20 ° C. to 37 ° C.,
Including a perfusate in the reservoir;
Measuring the parameters of the perfusate in the perfusion circuit, and processing the parameters to regulate at least one of the pumping and heating steps, and the collected liver is in a functional state for transplantation and How to stay alive .
40. The method of claim 39 , wherein the step of heating the perfusate comprises heating the perfusate to about 25C to about 37C.
40. The method of claim 39 , wherein the step of heating the perfusate comprises heating the perfusate to about 37 ° C.
40. The method of claim 39 , wherein providing the perfusate to the portal vein of the liver and providing the perfusate to the hepatic artery of the liver comprises providing heparin.
40. The method of claim 39 , wherein providing the perfusate to the portal vein of the liver and providing the perfusate to the hepatic artery of the liver comprises providing insulin.
40. The method of claim 39 , wherein providing the perfusate to the liver portal vein and providing the perfusate to the hepatic artery of the liver includes providing at least one nutrient.
40. The method of claim 39 , wherein providing the perfusate to the liver portal vein and providing the perfusate to the liver hepatic artery comprises providing at least one salt.
40. The method of claim 39 , wherein pumping the perfusate comprises pumping the perfusate using a centrifugal pump.
40. The method of claim 39 , wherein the parameter is a flow rate of perfusate in the perfusion circuit.
40. The method of claim 39 , wherein the parameter is oxygen level of perfusate in the perfusion circuit.
40. The method of claim 39 , wherein enriching the perfusate comprises enriching the perfusate using a membrane oxygenator.
40. The method of claim 39 , further comprising adjusting the perfusate in the perfusion circuit using at least one valve disposed in the perfusion circuit.
40. The method of claim 39 , further comprising displaying the parameter on a display.
JP2015240537A 1997-09-23 2015-12-09 Composition, method and apparatus for maintaining an organ Expired - Lifetime JP6134771B2 (en)
US08/936,062 1997-09-23
US08/936,062 US6100082A (en) 1997-09-23 1997-09-23 Perfusion apparatus and method including chemical compositions for maintaining an organ
US09/054,698 1998-04-03
US09/054,698 US6046046A (en) 1997-09-23 1998-04-03 Compositions, methods and devices for maintaining an organ
JP2016104750A JP2016104750A (en) 2016-06-09
JP2016104750A5 JP2016104750A5 (en) 2016-09-15
JP6134771B2 true JP6134771B2 (en) 2017-05-24
JP2011066448A Expired - Lifetime JP5746534B2 (en) 1997-09-23 2011-03-24 Composition, method and apparatus for maintaining an organ
JP2013251147A Expired - Lifetime JP5889861B2 (en) 1997-09-23 2013-12-04 Composition, method and apparatus for maintaining an organ
JP2014108177A Expired - Lifetime JP5923552B2 (en) 1997-09-23 2014-05-26 Composition, method and apparatus for maintaining an organ
JP2014108176A Expired - Lifetime JP5923551B2 (en) 1997-09-23 2014-05-26 Composition, method and apparatus for maintaining an organ
JP2014226896A Expired - Lifetime JP5933666B2 (en) 1997-09-23 2014-11-07 Composition, method and apparatus for maintaining an organ
JP2015240537A Expired - Lifetime JP6134771B2 (en) 1997-09-23 2015-12-09 Composition, method and apparatus for maintaining an organ
JP2015240695A Pending JP2016053081A (en) 1997-09-23 2015-12-10 Compositions, methods and devices for maintaining an organ
JP2017131257A Expired - Lifetime JP6347565B2 (en) 1997-09-23 2017-07-04 Composition, method and apparatus for maintaining an organ
JP (8) JP5746534B2 (en)
EP1439750A4 (en) * 2001-09-28 2004-10-27 Harry F Hull A simple, fully transportable device for maintaining an excised heart in optimum condition for transplantation
AU2015246083B9 (en) * 2004-10-07 2016-11-10 Transmedics, Inc. Systems and methods for ex-vivo organ care
US8900804B2 (en) * 2004-11-22 2014-12-02 Cedars-Sinai Medical Center Methods and solutions for tissue preservation
CA2605631A1 (en) * 2005-04-20 2006-10-26 Fred Hutchinson Cancer Research Center Methods, compositions and articles of manufacture for enhancing survivability of cells, tissues, organs, and organisms
ES2659970T3 (en) 2007-03-01 2018-03-20 Lifeline Scientific, Inc. Perfusion Regulation
JP2011512350A (en) 2008-02-15 2011-04-21 アメリカ合衆国 Blood substitute solution
US20120315618A1 (en) 2011-06-09 2012-12-13 Cell & Tissue Systems, Inc. Assessing, maintaining and/or restoring viability of organs/tissues
EP2750499B1 (en) 2011-09-02 2016-07-20 Organ Assist B.V. Apparatus, system and method for conditioning and preserving an organ from a donor
WO2013106908A1 (en) 2012-01-17 2013-07-25 University Of Manitoba Apparatus for testing, assessment, and maintenance of harvested hearts for transplanting
AU2013239682B2 (en) 2012-03-28 2016-03-31 Amgen Inc. DR5 receptor agonist combinations
CA2913060A1 (en) * 2013-06-14 2014-12-18 Perfusion Solutions Pty Ltd Cardiac function evaluation system
CA2943633A1 (en) * 2014-03-26 2015-10-01 Darren FREED Apparatus for maintenance of harvested hearts for transplanting
CN106581841A (en) * 2015-10-14 2017-04-26 天津艾博胜环保科技有限公司 Temperature-sensitive stem cell pumping system
DE102016225167B4 (en) 2016-12-15 2018-10-11 Otto-Von-Guericke-Universität Magdeburg Ex vivo pulmonary circulation and ventilation device and method for training surgical and minimally invasive surgical procedures
JP2860301B2 (en) * 1990-09-19 1999-02-24 ヘキスト・マリオン・ルセル株式会社 Solution for organ preservation
1997-09-23 US US08/936,062 patent/US6100082A/en not_active Expired - Lifetime
1998-04-03 US US09/054,698 patent/US6046046A/en not_active Expired - Lifetime
2011-03-24 JP JP2011066448A patent/JP5746534B2/en not_active Expired - Lifetime
2013-12-04 JP JP2013251147A patent/JP5889861B2/en not_active Expired - Lifetime
2014-05-26 JP JP2014108177A patent/JP5923552B2/en not_active Expired - Lifetime
2014-05-26 JP JP2014108176A patent/JP5923551B2/en not_active Expired - Lifetime
2014-11-07 JP JP2014226896A patent/JP5933666B2/en not_active Expired - Lifetime
2015-12-09 JP JP2015240537A patent/JP6134771B2/en not_active Expired - Lifetime
2015-12-10 JP JP2015240695A patent/JP2016053081A/en active Pending
2017-07-04 JP JP2017131257A patent/JP6347565B2/en not_active Expired - Lifetime
US6046046A (en) 2000-04-04
JP5923551B2 (en) 2016-05-24
JP6347565B2 (en) 2018-06-27
JP2014148553A (en) 2014-08-21
JP2014040491A (en) 2014-03-06
JP2016104750A (en) 2016-06-09
JP2015025023A (en) 2015-02-05
JP2014177484A (en) 2014-09-25
JP2011157374A (en) 2011-08-18
JP5923552B2 (en) 2016-05-24
JP5933666B2 (en) 2016-06-15
US6100082A (en) 2000-08-08
JP5889861B2 (en) 2016-03-22
JP2017165789A (en) 2017-09-21
JP2016053081A (en) 2016-04-14
JP5746534B2 (en) 2015-07-08
US8012677B2 (en) 2011-09-06 Evaluation and preservation solution
ES2250119T3 (en) 2006-04-16 Methods and means for the extracorporeal organ perfusion.
US7985536B2 (en) 2011-07-26 Method for regulating NO production in an isolated organ or tissue during warm perfusion
CN1127476A (en) 1996-07-24 Plasma-like solution
Neyrinck et al. 2006 Comparative study of donor lung injury in heart-beating versus non-heart-beating donors
US20070243518A1 (en) 2007-10-18 Continuous cardiac perfusion preservation with PEG-HB for improved hypothermic storage
JP2007519763A (en) 2007-07-19 Apparatus and method for determining the effect of a substance into an organ
CN1407853A (en) 2003-04-02 Device and method for performing biological modification of fluid
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