Graft repair during machine perfusion: a current overview of strategies.

IF 1.8 4区医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2024-08-01 Epub Date: 2024-05-10 DOI:10.1097/MOT.0000000000001151

Roberto Broere, Stefan H Luijmes, Jeroen de Jonge, Robert J Porte

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Abstract

Purpose of review: With changing donor characteristics (advanced age, obesity), an increase in the use of extended criteria donor (ECD) livers in liver transplantation is seen. Machine perfusion allows graft viability assessment, but still many donor livers are considered nontransplantable. Besides being used as graft viability assessment tool, ex situ machine perfusion offers a platform for therapeutic strategies to ameliorate grafts prior to transplantation. This review describes the current landscape of graft repair during machine perfusion.

Recent findings: Explored anti-inflammatory therapies, including inflammasome inhibitors, hemoabsorption, and cellular therapies mitigate the inflammatory response and improve hepatic function. Cholangiocyte organoids show promise in repairing the damaged biliary tree. Defatting during normothermic machine perfusion shows a reduction of steatosis and improved hepatobiliary function compared to nontreated livers. Uptake of RNA interference therapies during machine perfusion paves the way for an additional treatment modality.

Summary: The possibility to repair injured donor livers during ex situ machine perfusion might increase the utilization of ECD-livers. Application of defatting agents is currently explored in clinical trials, whereas other therapeutics require further research or optimization before entering clinical research.

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机器灌注期间的移植物修复：当前策略概述。

回顾的目的：随着供体特征的变化（高龄、肥胖），肝移植中使用扩展标准供体（ECD）肝脏的情况越来越多。机器灌注可以评估移植物的存活能力，但仍有许多供体肝脏被认为不能移植。除了用作移植物存活率评估工具外，原位机器灌注还为移植前改善移植物的治疗策略提供了一个平台。本综述介绍了目前机器灌注过程中移植物修复的情况：最新发现：已探索出的抗炎疗法（包括炎性体抑制剂、血液吸收和细胞疗法）可减轻炎症反应并改善肝功能。胆管细胞器官组织有望修复受损胆管。与未经处理的肝脏相比，在常温机器灌注过程中进行脱脂可减轻脂肪变性并改善肝胆功能。摘要：在原位机器灌注过程中修复受损供体肝脏的可能性可能会提高 ECD 肝脏的利用率。目前正在临床试验中探索脱脂剂的应用，而其他疗法则需要进一步研究或优化后才能进入临床研究。

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来源期刊

Current Opinion in Organ Transplantation 医学-移植

CiteScore

4.10

自引率

4.50%

发文量

124

审稿时长

6-12 weeks

期刊介绍： Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.

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