Perfusion Pressures and Weight Loss During Normothermic Machine Perfusion of Human Donor Livers.

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL Artificial organs Pub Date : 2024-12-31 DOI:10.1111/aor.14939

Bianca Lascaris, Silke B Bodewes, Adam M Thorne, Marius C van den Heuvel, Robbert J de Haas, Maarten W N Nijsten, Vincent E de Meijer, Robert J Porte

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Abstract

Background: Normothermic machine perfusion (NMP) is increasingly used to preserve and assess donor livers prior to transplantation. Due to its success, it is expected that more centers will start using this technology. However, NMP may also cause adverse effects.

Methods: In this retrospective, observational study, we investigated the effect of NMP pressures on donor liver weight, post-transplant outcomes, and hepatic perfusion characteristics. A total of 36 livers were transplanted after NMP. NMP perfusion pressure settings were lowered from a median (IQR) of 47 mmHg (42-54) to 34 mmHg (30-39) for the hepatic artery (HA), and from 8 mmHg (7-10) to 7 mmHg (6-8) for the portal vein (PV) to diminish potential edema formation inside the liver.

Results: This change appeared to lead to a reduction of liver weight after NMP (-22 g to -143 g, p = 0.02), without affecting the PV flow velocity (35.5 to 48.0 cm/s, p = 0.54), or hepatocellular injury markers during NMP (AST 1511-1148 U/L, p = 0.44; ALT 318-849 U/L, p = 0.35), and post-transplantation outcomes. Changes in liver weight correlated significantly with the applied PV pressure during NMP (r = 0.52, p < 0.01) and the HA flow (r = 0.38, p < 0.05).

Conclusion: NMP can lead to a reduction in liver weight, which might be masked by edema when high perfusion pressures are used. We encourage applying the lowest perfusion pressures possible to reach adequate flows and oxygen supply during liver NMP.

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人供肝常温机器灌注过程中的灌注压力和体重减轻。

背景：常温机器灌注（NMP）越来越多地用于移植前保存和评估供肝。由于它的成功，预计会有更多的中心开始使用这项技术。然而，NMP也可能引起不良反应。方法：在这项回顾性观察性研究中，我们研究了NMP压力对供肝重量、移植后预后和肝灌注特征的影响。NMP术后共移植36例肝脏。肝动脉（HA）的NMP灌注压力设置中位数（IQR）从47 mmHg（42-54）降至34 mmHg(30-39)，门静脉（PV）的NMP灌注压力设置从8 mmHg（7-10）降至7 mmHg(6-8)，以减少肝内潜在水肿形成。结果：这种变化似乎导致NMP后肝脏重量减轻（-22 g至-143 g， p = 0.02），但不影响PV流速（35.5至48.0 cm/s, p = 0.54），也不影响NMP期间肝细胞损伤标志物(AST 1511-1148 U/L, p = 0.44；ALT 318-849 U/L, p = 0.35)和移植后预后。肝重量的变化与NMP期间施加的PV压力显著相关（r = 0.52, p）。结论：NMP可导致肝重量的减轻，但在使用高灌注压力时可能被水肿所掩盖。我们鼓励在肝脏NMP期间应用尽可能低的灌注压力以达到足够的流量和氧气供应。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.