Abstract
BACKGROUND AND OBJECTIVE: Hemadsorption, a therapeutic modality traditionally used to mitigate cytokine storm in critically ill patients and is now being tested in other medical fields including organ transplantation, especially for organs from extended criteria donors. Such organs are susceptible to ischemia-reperfusion injury (IRI) during transplantation, which is known to release a cascade of innate immune mediators including damage-associated molecular patterns (DAMPs) and cytokines during reperfusion and ultimately leading to graft dysfunction based on the metabolic injury. To address this challenge, early studies have integrated hemadsorption filters into organ perfusion circuits, such as normothermic regional perfusion (NRP) in donors and ex-situ machine perfusion (MP) of grafts, with the aim to reduce inflammation and improve organ viability. While results indicated a benefit with this use, the data are limited, and the subcellular response mechanisms impacted by such filters remain unexplored. This narrative review explores the impact of hemadsorption devices from critical conditions to organ preservation, highlighting technical opportunities, benefits, current challenges, and potential effects on outcomes. METHODS: This review examines the application of hemadsorption in critically ill patients and in organ transplantation. KEY CONTENT AND FINDINGS: In complex clinical scenarios like sepsis and cardiac surgery, where systemic inflammatory responses are severe, hemadsorption alone may not be sufficient, requiring a comprehensive approach involving antimicrobial therapy, resuscitation, and immunomodulatory treatments to achieve immune homeostasis. In organ transplantation, hemadsorption shows potential benefits, but further clinical research is needed to optimize its use and to understand the impact of perfusates recirculating molecules on tissue metabolism during MP. CONCLUSIONS: While hemadsorption requires thoughtful evaluation and adjunctive therapies in common critical clinical applications, it presents promising potential in the field of organ transplantation, particularly in organ preservation.