Director of Clinic / Institute: Dr. Bettina Wiegmann
Keywords: Ex-vivo lung perfusion, ex-vivo heart perfusion, Organ Care System, XVIVO-System, ex-vivo regeneration, ex-vivo immune therapy, ex-vivo gene therapy, ex-vivo tumor therapy, ex-vivo infection therapy
Due to the increasing mismatch between the number of available organ donors to the organ recipients more and more patients on the organ waiting list will die before their transplantation. In addition, within organ transplantation ischemia-reperfusion injury cause acute life-threatening transplant failure and chronic rejection of the organs. In order to tackle these limitations, ex-vivo perfusion systems for donor organs (e.g. heart, liver, lung, kidney) have been developed within the past years to allow a greater geographical flexibility in terms of organ donor management, additionally facilitating the re-evaluation of potential donor organs, thereby increasing the number of available transplants. The ex-vivo systems enable organ perfusion with a nutrient solution at body temperature, which attributes to a significant reduction of ischemia-reperfusion injuries and the concomitant improved outcome after organ transplantation.
The working group deals with the optimisation of the ex-vivo organ perfusion, also to broaden the spectrum of ex-vivo organ perfusion technology to further possible applications (e.g. ex-vivo limb perfusion) in the context of allogenic transplantation. Modern medicine paved the way for additional possible interdisciplinary ex-vivo therapy concepts, which can additionally be used in the setting of autologous replantation after the specific ex-vivo organ therapy. Notably, the investigated concepts include highly innovative strategies derived from the fields of regenerative-, immunological-, cell based-, pharmacological-, as well as anti-tumour and anti-infectious therapies for ex-vivo perfused organs. Following the translational idea, in this context the diseased organ could be treated ex-vivo, while the patient is stabilised using the respective artificial organ substitute device (e.g. dialysis, extracorporeal membrane oxygenation, cardiopulmonary bypass technology) until the organ is ready for autologous replantation.
Within the framework of different interdisciplinary projects, ex-vivo therapy concepts are compared with the conventional in-vivo therapies using small- and large animal models
The expertise of the group allows for the individual and project specific adaption of the ex-vivo perfusion devices to match specific requirements (e. g. CT-/MRI-application)
Furthermore, ex-vivo application enables the adjustment of the ex-vivo environment, such as the perfusion pressure, flow rate, the saturation of the perfusate (e.g. pO2, pCO2, hemoglobin)
In addition, the group focuses on the development, analysis and establishment of the following novel therapy concepts regarding allogenic transplantation and autologous replantation:
Regenerative ex-vivo medicine / tissue engineering / cell-based therapies
Ex-vivo tumour therapy (ex-vivo radiation therapy and high dose chemotherapy)
Ex-vivo immune therapy (e.g. ex-vivo MHC-silencing)
Ex-vivo infection therapy (e.g. application of high dose antibiotic therapy)
Ex-vivo gene therapy (e.g. ex- vivo correction of genetic diseases)
The ex-vivo therapy holds great advantages over the in-vivo therapy due to the fact that it is locally restricted to an isolated and easily accessible organ, where systemic side effects of the therapeutic agent on other organs can be excluded. This enables inter alia the administration of increased dosages of pharmaceuticals, consecutive more effective therapies