Quantifying Flavin mononucleotide: an internationally validated methodological approach for enhanced decision making in organ transplantation
Keyue Sun, Chunbao Jiao, Rebecca Panconesi, Sangeeta Satish, O Karakaya, Femke H.C. de Goeij, Tobias Diwan, Khaled Ali, Lorenzo A Cadinu, Beatrice Cazzaniga, Qiang Liu, Yuki Miyazaki, Alejandro Pita, Mazhar Khalil, JaeKeun Kim, Ahmed Hussein, Philip C. Müller, Federico Aucejo, D. Kwon, Eduardo Fernandes, Jamak Modaresi Esfeh, Jacek B. Cywiński, Masato Fujiki, Lidong Sun, Antonio Daniele Pinna, Philipp Dutkowski, Chase J. Wehrle, Robert L. Fairchild, David Meierhofer, Jeroen de Jonge, Charles W. Miller, Koji Hashimoto, Andrea Schlegel
Abstract
BACKGROUND: Increasing donor risk, particularly in liver transplantation, where organs are often marginal, has made dynamic organ preservation techniques and viability assessment essential to safely improve organ quality and increase utilisation. However, existing viability parameters are based on routine clinical assessment in patients with acute liver failure, trauma, or liver resections. These parameters often do not correlate with clinically relevant post-transplant outcomes. METHODS: This article presents a detailed protocol for the spectrophotometric quantification of Flavin mononucleotide (FMN), a marker of mitochondrial injury. FMN release from mitochondrial complex I was described many decades ago as the initial sign of ischaemia-reperfusion injury, i.e. when oxygen is reintroduced in ischaemic tissues during organ transplantation or machine perfusion. This study describes the detailed FMN quantification in donor plasma and various fluids obtained during machine perfusion, and discusses confounders, challenges, and the role of individual test components. FINDINGS: FMN quantification was identified as an immediate organ assessment tool, demonstrating a strong correlation with graft survival and other relevant complications after human liver transplantation. INTERPRETATION: The results highlight FMN quantification as a reliable and standardized method for assessing organ viability, offering significant potential for improving organ selection and better utilisation. This method could provide better a predictive value for transplant outcomes compared to existing parameters currently in use. FUNDING: This research received no external funding but was supported by the Catalyst grant No. CCG0280 at Cleveland Clinic Ohio, U.S. dedicated to A.S.