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Machine perfusion in liver transplantation: recent advances and coming challenges. 肝移植中的机器灌注:最新进展与未来挑战。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2024-05-09 DOI: 10.1097/MOT.0000000000001150
Chase J Wehrle, Chunbao Jiao, Keyue Sun, Mingyi Zhang, Robert L Fairchild, Charles Miller, Koji Hashimoto, Andrea Schlegel

Purpose of review: Machine perfusion has been adopted into clinical practice in Europe since the mid-2010s and, more recently, in the United States (US) following approval of normothermic machine perfusion (NMP). We aim to review recent advances, provide discussion of potential future directions, and summarize challenges currently facing the field.

Recent findings: Both NMP and hypothermic-oxygenated perfusion (HOPE) improve overall outcomes after liver transplantation versus traditional static cold storage (SCS) and offer improved logistical flexibility. HOPE offers additional protection to the biliary system stemming from its' protection of mitochondria and lessening of ischemia-reperfusion injury. Normothermic regional perfusion (NRP) is touted to offer similar protective effects on the biliary system, though this has not been studied prospectively.The most critical question remaining is the optimal use cases for each of the three techniques (NMP, HOPE, and NRP), particularly as HOPE and NRP become more available in the US. There are additional questions regarding the most effective criteria for viability assessment and the true economic impact of these techniques. Finally, with each technique purported to allow well tolerated use of riskier grafts, there is an urgent need to define terminology for graft risk, as baseline population differences make comparison of current data challenging.

Summary: Machine perfusion is now widely available in all western countries and has become an essential tool in liver transplantation. Identification of the ideal technique for each graft, optimization of viability assessment, cost-effectiveness analyses, and proper definition of graft risk are the next steps to maximizing the utility of these powerful tools.

审查目的:自 2010 年代中期以来,机器灌注已在欧洲应用于临床实践,最近,在常温机器灌注(NMP)获得批准后,机器灌注也在美国应用于临床实践。我们旨在回顾最近的进展,讨论潜在的未来方向,并总结该领域目前面临的挑战:与传统的静态冷藏(SCS)相比,常温机灌注(NMP)和低温氧合灌注(HOPE)都能改善肝移植术后的总体疗效,并提高物流的灵活性。HOPE 可保护线粒体,减轻缺血再灌注损伤,从而为胆道系统提供额外保护。剩下的最关键问题是这三种技术(NMP、HOPE 和 NRP)各自的最佳使用情况,尤其是随着 HOPE 和 NRP 在美国的普及。此外,还有一些问题涉及可行性评估的最有效标准以及这些技术的真正经济影响。最后,由于每种技术都声称可以很好地耐受风险较高的移植物,因此迫切需要定义移植物风险的术语,因为基线人群的差异使得比较当前的数据具有挑战性。摘要:机器灌注现已在所有西方国家广泛使用,并已成为肝移植的重要工具。确定每种移植物的理想技术、优化存活率评估、成本效益分析以及正确定义移植物风险是最大限度发挥这些强大工具效用的下一步工作。
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引用次数: 0
Liver transplantation for tumor entities. 肿瘤实体肝移植。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2024-05-08 DOI: 10.1097/MOT.0000000000001149
Damiano Patrono, Nicola De Stefano, Renato Romagnoli

Purpose of review: Tumor entities represent an increasing indication for liver transplantation (LT). This review addresses the most contentious indications of LT in transplant oncology.

Recent findings: Patient selection based on tumor biology in LT for colorectal cancer liver metastases (CRLM) demonstrated promising long-term outcomes and preserved quality of life despite high recurrence rates. In selected cases, LT for intrahepatic cholangiocarcinoma (iCCA) is feasible, with acceptable survival even in high-burden cases responsive to chemotherapy. LT following a strict neoadjuvant protocol for perihilar cholangiocarcinoma (pCCA) resulted in long-term outcomes consistently surpassing benchmark values, and potentially outperforming liver resection.

Summary: While preliminary results are promising, prospective trials are crucial to define applications in routine clinical practice. Molecular profiling and targeted therapies pave the way for personalized approaches, requiring evolving allocation systems for equitable LT access.

审查目的:肿瘤实体是肝移植(LT)越来越多的适应症。本综述探讨了移植肿瘤学中最有争议的肝移植适应症:尽管复发率较高,但在治疗结直肠癌肝转移(CRLM)的肝移植中,基于肿瘤生物学的患者选择显示出良好的长期疗效和生活质量。在经过选择的病例中,肝内胆管癌(iCCA)的LT治疗是可行的,即使是对化疗有反应的高负担病例,其生存率也是可以接受的。对肝周胆管癌(pCCA)采用严格的新辅助方案进行LT治疗,其长期疗效一直超过基准值,并有可能优于肝切除术。摘要:虽然初步结果令人鼓舞,但前瞻性试验对于确定常规临床实践中的应用至关重要。分子图谱分析和靶向治疗为个性化方法铺平了道路,需要不断发展的分配系统来实现公平的LT使用。
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引用次数: 0
Cardiac evaluation of the liver transplant candidate. 肝移植候选人的心脏评估。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2023-11-23 DOI: 10.1097/MOT.0000000000001122
Stephen Possick, Vandana Khungar, Ranjit Deshpande

Purpose of review: This review aims to summarize recent changes in the cardiac evaluation of adult liver transplant candidates. Over the last several years, there have been significant advances in the use of coronary computed tomography angiography (CCTA) with and without fractional flow reserve (FFR) and increasingly widespread availability of coronary calcium scoring for risk stratification for obstructive coronary artery disease. This has led to novel strategies for risk stratification in cirrhotic patients being considered for liver transplant and an updated American Heart Association (AHA) position paper on the evaluation of liver and kidney transplant candidates. The diagnosis of cirrhotic cardiomyopathy has been refined. These new diagnostic criteria require that specific echocardiographic parameters are evaluated in all patients. The definition of pulmonary hypertension on echocardiography has been altered and no longer utilizes right atrium (RA) pressure estimates based on inferior vena cava (IVC) size and collapse. This provides more volume neutral estimates of pulmonary pressure.

Recent findings: Although CCTA has outstanding negative predictive value, false positive results are not uncommon and often lead to further testing. Revised diagnostic criteria for cirrhotic cardiomyopathy improve risk stratification for peri-operative volume overload and outcomes. Refined pulmonary hypertension criteria provide improved guidance for right heart catheterization (RHC) and referral to subspecialists. There are emerging data regarding the safety and efficacy of TAVR for severe aortic stenosis in cirrhotic patients.

Summary: Increased utilization of noninvasive testing, including CCTA and/or coronary calcium scoring, can improve the negative predictive value of testing for obstructive coronary artery disease and potentially reduce reliance on coronary angiography. Application of the 2020 criteria for cirrhotic cardiomyopathy will improve systolic and diastolic function assessment and subsequent perioperative risk stratification. The use of global strain scores is emphasized, as it provides important information beyond ejection fraction and diastolic parameters. A standardized one-parameter echo cut-off for elevated pulmonary pressures simplifies both evaluation and follow-up. Innovative transcutaneous techniques for valvular stenosis and regurgitation offer new options for patients at prohibitive surgical risk.

综述目的:本综述旨在总结成人肝移植候选人心脏评估的最新变化。在过去的几年中,冠状动脉计算机断层血管造影(CCTA)在有或没有分数血流储备(FFR)的情况下取得了重大进展,冠状动脉钙评分在阻塞性冠状动脉疾病的风险分层中的应用日益广泛。这导致了考虑肝移植的肝硬化患者风险分层的新策略,以及美国心脏协会(AHA)关于评估肝和肾移植候选人的最新立场文件。肝硬化心肌病的诊断已得到改进。这些新的诊断标准要求在所有患者中评估特定的超声心动图参数。超声心动图上肺动脉高压的定义已经改变,不再使用基于下腔静脉(IVC)大小和塌陷的右心房(RA)压力估计。这提供了更多的肺压力体积中性估计。最近发现:虽然CCTA具有突出的阴性预测价值,但假阳性结果并不罕见,通常需要进一步检查。修订的肝硬化心肌病诊断标准改善了围手术期容量超载和预后的风险分层。完善的肺动脉高压标准为右心导管(RHC)和转介到专科医生提供了更好的指导。关于TAVR治疗肝硬化严重主动脉瓣狭窄患者的安全性和有效性的新数据。总结:增加无创检测的使用,包括CCTA和/或冠状动脉钙评分,可以提高检测对阻塞性冠状动脉疾病的阴性预测价值,并可能减少对冠状动脉造影的依赖。2020年肝硬化心肌病标准的应用将改善收缩和舒张功能评估以及随后的围手术期风险分层。强调整体应变评分的使用,因为它提供了射血分数和舒张参数之外的重要信息。一个标准化的单参数回声切断为肺动脉压升高简化了评估和随访。创新的经皮瓣膜狭窄和反流技术为那些有手术风险的患者提供了新的选择。
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引用次数: 0
Exercise training in solid organ transplant candidates and recipients. 实体器官移植候选者和接受者的运动训练。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2024-06-06 DOI: 10.1097/MOT.0000000000001158
Nicholas Bourgeois, Catherine M Tansey, Tania Janaudis-Ferreira

Purpose of review: Exercise training programs are an integral part of the management of solid organ transplantation (SOT) candidates and recipients. Despite this, they are not widely available and specific guidelines on exercise parameters for each type of organ are not currently provided. A review of this topic could help clinicians to prescribe appropriate exercise regimens for their patients.

Recent findings: In this narrative review, we discuss the physical impairments of SOT candidates and recipients and how these affect their physical function and transplant outcomes. We examine recent systematic reviews, statements, and randomized controlled trials on exercise training in SOT candidates and recipients and present the current available evidence while providing some practical recommendations for clinicians based on the frequency, intensity, time, and type principle.

Summary: While randomized controlled trials of better methodology quality are needed to strengthen the evidence for the effects of exercise training and for the optimal training characteristics, the available evidence points to beneficial effects of many different types of exercise. The current evidence can provide some guidance for clinicians on the prescription of exercise training for transplant candidates and recipients.

审查目的:运动训练计划是实体器官移植(SOT)候选者和受者管理不可或缺的一部分。尽管如此,运动训练计划并不普及,目前也没有针对每种器官类型的运动参数提供具体指导。对这一主题的综述有助于临床医生为患者制定适当的运动方案:在这篇叙述性综述中,我们讨论了 SOT 候选者和受者的身体缺陷,以及这些缺陷如何影响他们的身体功能和移植结果。我们研究了最近关于 SOT 候选者和受者运动训练的系统综述、声明和随机对照试验,并介绍了当前可用的证据,同时根据频率、强度、时间和类型原则为临床医生提供了一些实用建议。总结:虽然需要方法质量更高的随机对照试验来加强运动训练效果和最佳训练特征的证据,但现有证据表明许多不同类型的运动都有益处。目前的证据可以为临床医生为移植候选者和受者开具运动训练处方提供一些指导。
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引用次数: 0
Graft repair during machine perfusion: a current overview of strategies. 机器灌注期间的移植物修复:当前策略概述。
IF 1.8 4区 医学 Q3 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

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.

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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引用次数: 0
Fueling the success of transplantation through nutrition: recent insights into nutritional interventions, their interplay with gut microbiota and cellular mechanisms. 通过营养促进移植成功:对营养干预、其与肠道微生物群和细胞机制的相互作用的最新见解。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2024-06-10 DOI: 10.1097/MOT.0000000000001159
Felix C Koehler, Martin R Späth, Anna M Meyer, Roman-Ulrich Müller

Purpose of review: The role of nutrition in organ health including solid organ transplantation is broadly accepted, but robust data on nutritional regimens remains scarce calling for further investigation of specific dietary approaches at the different stages of organ transplantation. This review gives an update on the latest insights into nutritional interventions highlighting the potential of specific dietary regimens prior to transplantation aiming for organ protection and the interplay between dietary intake and gut microbiota.

Recent findings: Nutrition holds the potential to optimize patients' health prior to and after surgery, it may enhance patients' ability to cope with the procedure-associated stress and it may accelerate their recovery from surgery. Nutrition helps to reduce morbidity and mortality in addition to preserve graft function. In the case of living organ donation, dietary preconditioning strategies promise novel approaches to limit ischemic organ damage during transplantation and to identify the underlying molecular mechanisms of diet-induced organ protection. Functioning gut microbiota are required to limit systemic inflammation and to generate protective metabolites such as short-chain fatty acids or hydrogen sulfide.

Summary: Nutritional intervention is a promising therapeutic concept including the pre- and rehabilitation stage in order to improve the recipients' outcome after solid organ transplantation.

综述目的:营养在器官健康(包括实体器官移植)中的作用已被广泛接受,但有关营养方案的可靠数据仍然很少,因此需要进一步研究器官移植不同阶段的特定饮食方法。本综述介绍了营养干预的最新进展,强调了移植前特定膳食方案在器官保护方面的潜力,以及膳食摄入与肠道微生物群之间的相互作用:营养具有优化患者术前术后健康的潜力,可增强患者应对手术相关压力的能力,并可加快患者术后恢复。营养有助于降低发病率和死亡率,并能保持移植物的功能。在活体器官捐献的情况下,饮食预处理策略有望成为限制移植过程中缺血性器官损伤的新方法,并确定饮食诱导器官保护的潜在分子机制。小结:营养干预是一个很有前景的治疗概念,包括前期和康复阶段,以改善实体器官移植后受者的预后。
{"title":"Fueling the success of transplantation through nutrition: recent insights into nutritional interventions, their interplay with gut microbiota and cellular mechanisms.","authors":"Felix C Koehler, Martin R Späth, Anna M Meyer, Roman-Ulrich Müller","doi":"10.1097/MOT.0000000000001159","DOIUrl":"10.1097/MOT.0000000000001159","url":null,"abstract":"<p><strong>Purpose of review: </strong>The role of nutrition in organ health including solid organ transplantation is broadly accepted, but robust data on nutritional regimens remains scarce calling for further investigation of specific dietary approaches at the different stages of organ transplantation. This review gives an update on the latest insights into nutritional interventions highlighting the potential of specific dietary regimens prior to transplantation aiming for organ protection and the interplay between dietary intake and gut microbiota.</p><p><strong>Recent findings: </strong>Nutrition holds the potential to optimize patients' health prior to and after surgery, it may enhance patients' ability to cope with the procedure-associated stress and it may accelerate their recovery from surgery. Nutrition helps to reduce morbidity and mortality in addition to preserve graft function. In the case of living organ donation, dietary preconditioning strategies promise novel approaches to limit ischemic organ damage during transplantation and to identify the underlying molecular mechanisms of diet-induced organ protection. Functioning gut microbiota are required to limit systemic inflammation and to generate protective metabolites such as short-chain fatty acids or hydrogen sulfide.</p><p><strong>Summary: </strong>Nutritional intervention is a promising therapeutic concept including the pre- and rehabilitation stage in order to improve the recipients' outcome after solid organ transplantation.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141300222","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
The Liver Frailty Index: a model for establishing organ-specific frailty metrics across all solid organ transplantation. 肝脏虚弱指数:在所有实体器官移植中建立器官特异性虚弱指标的模型。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2024-06-05 DOI: 10.1097/MOT.0000000000001157
Gabrielle Jutras, Jennifer C Lai

Purpose of review: In this review, we discuss the development of the Liver Frailty Index (LFI) and how it may serve as a model for developing other organ-specific frailty indices.

Recent findings: As the demand for solid organ transplants continues to increase, the transplantation community is enhancing its strategies for organ allocation to gain deeper insights into patient risk profiles and anticipated outcomes. Frailty has emerged as a critical concept in transplant care, offering valuable insights into adverse health outcomes. Standardizing frailty assessment across transplant programs could enhance prognostic accuracy and inform pretransplant interventions.The LFI comprises of three performance-based tests that each represents essential components of the multidimensional frailty construct. This composite metric provides insights beyond liver function and considers nonhepatic comorbid factors. Identifying common frailty principles among all transplant candidates and adopting the LFI methodology, which assesses fundamental frailty principles using liver-specific tools, could establish a foundational pool of shared core frailty principles. From this pool, organ-specific frailty indices could be derived, each equipped with the clinically relevant organ-specific tools to evaluate common core principles.

Summary: Creating a standardized framework across all solid-organ transplants, with common principles and organ-specific measurements, would facilitate consistent frailty assessment, standardize the integration of the frailty construct into transplant decision-making, and enable center-level interventions to improve outcomes for patients with end-stage organ disease.

综述的目的:在这篇综述中,我们讨论了肝脏虚弱指数(LFI)的发展,以及如何将其作为发展其他器官特异性虚弱指数的模型:随着对实体器官移植的需求不断增加,移植界正在加强其器官分配策略,以便更深入地了解患者的风险状况和预期结果。虚弱已成为移植护理中的一个重要概念,它为了解不良健康结果提供了宝贵的信息。在移植项目中实现虚弱评估的标准化可以提高预后的准确性,并为移植前的干预措施提供依据。LFI由三个基于性能的测试组成,每个测试都代表了多维虚弱结构的重要组成部分。这一综合指标提供了肝功能以外的见解,并考虑了非肝合并症因素。在所有移植候选者中识别共同的虚弱原则并采用 LFI 方法(该方法使用肝脏特异性工具评估基本虚弱原则),可以建立一个共享核心虚弱原则的基础库。小结:在所有实体器官移植中建立一个标准化框架,采用共同的原则和器官特异性测量方法,将有助于进行一致的虚弱评估,将虚弱结构标准化地纳入移植决策,并使中心一级的干预措施能够改善终末期器官疾病患者的预后。
{"title":"The Liver Frailty Index: a model for establishing organ-specific frailty metrics across all solid organ transplantation.","authors":"Gabrielle Jutras, Jennifer C Lai","doi":"10.1097/MOT.0000000000001157","DOIUrl":"10.1097/MOT.0000000000001157","url":null,"abstract":"<p><strong>Purpose of review: </strong>In this review, we discuss the development of the Liver Frailty Index (LFI) and how it may serve as a model for developing other organ-specific frailty indices.</p><p><strong>Recent findings: </strong>As the demand for solid organ transplants continues to increase, the transplantation community is enhancing its strategies for organ allocation to gain deeper insights into patient risk profiles and anticipated outcomes. Frailty has emerged as a critical concept in transplant care, offering valuable insights into adverse health outcomes. Standardizing frailty assessment across transplant programs could enhance prognostic accuracy and inform pretransplant interventions.The LFI comprises of three performance-based tests that each represents essential components of the multidimensional frailty construct. This composite metric provides insights beyond liver function and considers nonhepatic comorbid factors. Identifying common frailty principles among all transplant candidates and adopting the LFI methodology, which assesses fundamental frailty principles using liver-specific tools, could establish a foundational pool of shared core frailty principles. From this pool, organ-specific frailty indices could be derived, each equipped with the clinically relevant organ-specific tools to evaluate common core principles.</p><p><strong>Summary: </strong>Creating a standardized framework across all solid-organ transplants, with common principles and organ-specific measurements, would facilitate consistent frailty assessment, standardize the integration of the frailty construct into transplant decision-making, and enable center-level interventions to improve outcomes for patients with end-stage organ disease.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":1.8,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141246987","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Viability assessment of the liver during ex-situ machine perfusion prior to transplantation. 移植前原位机器灌注期间的肝脏活力评估。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2024-05-17 DOI: 10.1097/MOT.0000000000001152
Puck C Groen, Otto B van Leeuwen, Jeroen de Jonge, Robert J Porte

Purpose of review: In an attempt to reduce waiting list mortality in liver transplantation, less-than-ideal quality donor livers from extended criteria donors are increasingly accepted. Predicting the outcome of these organs remains a challenge. Machine perfusion provides the unique possibility to assess donor liver viability pretransplantation and predict postreperfusion organ function.

Recent findings: Assessing liver viability during hypothermic machine perfusion remains challenging, as the liver is not metabolically active. Nevertheless, the levels of flavin mononucleotide, transaminases, lactate dehydrogenase, glucose and pH in the perfusate have proven to be predictors of liver viability. During normothermic machine perfusion, the liver is metabolically active and in addition to the perfusate levels of pH, transaminases, glucose and lactate, the production of bile is a crucial criterion for hepatocyte viability. Cholangiocyte viability can be determined by analyzing bile composition. The differences between perfusate and bile levels of pH, bicarbonate and glucose are good predictors of freedom from ischemic cholangiopathy.

Summary: Although consensus is lacking regarding precise cut-off values during machine perfusion, there is general consensus on the importance of evaluating both hepatocyte and cholangiocyte compartments. The challenge is to reach consensus for increased organ utilization, while at the same time pushing the boundaries by expanding the possibilities for viability testing.

审查目的:为了降低肝移植等待名单上的死亡率,越来越多的肝移植患者接受了来自扩展标准捐献者的质量不理想的捐献肝脏。预测这些器官的移植结果仍是一项挑战。机器灌注为移植前评估供体肝脏存活能力和预测再灌注后器官功能提供了独特的可能性:由于肝脏的新陈代谢并不活跃,因此在低体温机器灌注过程中评估肝脏存活能力仍具有挑战性。然而,灌注液中的黄素单核苷酸、转氨酶、乳酸脱氢酶、葡萄糖和pH值已被证明是预测肝脏存活能力的指标。在常温机器灌流期间,肝脏代谢活跃,除了灌流液中的 pH 值、转氨酶、葡萄糖和乳酸水平外,胆汁的生成也是肝细胞存活率的一个重要标准。胆管细胞活力可通过分析胆汁成分来确定。灌注液和胆汁中 pH 值、碳酸氢盐和葡萄糖水平之间的差异是预测缺血性胆管病变的良好指标。摘要:尽管在机器灌注过程中对精确的临界值缺乏共识,但对评估肝细胞和胆管细胞的重要性已达成普遍共识。我们面临的挑战是达成共识以提高器官利用率,同时通过扩大存活率测试的可能性来突破界限。
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引用次数: 0
How to cultivate sustainable physical health and wellness in transplant recipients: the emerging and enduring role of exercise scientists. 如何培养移植受者可持续的身体健康和保健能力:运动科学家的新兴和持久作用。
IF 1.8 4区 医学 Q3 TRANSPLANTATION Pub Date : 2024-08-01 Epub Date: 2024-06-06 DOI: 10.1097/MOT.0000000000001160
Giorgos K Sakkas, Christoforos D Giannaki, Kenneth R Wilund, Christina Karatzaferi

Purpose of review: The aim of the current review is to highlight the importance of exercise training as an important section of transplant recipient rehabilitation process and explain the role of the exercise scientist in the development, implementation, and assessment of the exercise regime.

Recent findings: Transplant patients face a unique set of challenges in their recovery and rehabilitation process, often requiring a multifaceted approach to address the physical, emotional, and psychological aspects of their condition. Exercise training has emerged as a crucial component in the care of these patients, providing a means to improve functional capacity, enhance quality of life, and mitigate the adverse effects of transplant-related complications. Exercise scientists who are trained to assess patient's physical limitations, develop and deliver personalized exercise programs, and monitor their progress are uniquely positioned to play a crucial role in the treatment of patients with chronic conditions that require exercise training as a mean of improving and maintaining health and quality of life.

Summary: Exercise scientists are the appropriate professionals for providing transplant recipients with the recommended exercise training for maintaining and improving their health status as part of the overall plan of long-term care and support.

综述目的:本综述旨在强调运动训练作为移植受者康复过程中一个重要环节的重要性,并解释运动科学家在运动制度的制定、实施和评估中的作用:移植患者在恢复和康复过程中面临着一系列独特的挑战,通常需要采取多方面的方法来解决其身体、情绪和心理方面的问题。运动训练已成为治疗这些病人的一个重要组成部分,它提供了一种改善功能、提高生活质量和减轻移植相关并发症不良影响的方法。运动科学家接受过评估患者身体限制、制定和实施个性化运动计划并监测其进展的培训,他们在治疗需要通过运动训练来改善和维持健康及生活质量的慢性病患者方面具有独特的优势,可以发挥至关重要的作用。摘要:运动科学家是为移植受者提供建议运动训练以维持和改善其健康状况的合适专业人员,这也是长期护理和支持总体计划的一部分。
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引用次数: 0
Abdominal normothermic regional perfusion in the United States: current state and future directions. 美国的腹部常温区域灌注:现状与未来方向。
IF 2.2 4区 医学 Q2 Medicine Pub Date : 2024-06-01 Epub Date: 2024-03-20 DOI: 10.1097/MOT.0000000000001144
Anji Wall, Amar Gupta, Giuliano Testa

Purpose of review: Normothermic regional perfusion (NRP) is a novel procurement technique for donation after circulatory death (DCD) in the United States. It was pioneered by cardiothoracic surgery programs and is now being applied to abdominal-only organ donors by abdominal transplant programs.

Recent findings: Liver and kidney transplantation from thoracoabdominal NRP (TA-NRP) donors in the United States was found to have lower rates of delayed kidney graft function and similar graft and patient survival versus recipients of cardiac super rapid recovery (SRR) DCD donors. The excellent outcomes with NRP have prompted the expansion of NRP technology to abdominal transplant programs.

Summary: Excellent early outcomes with liver and kidney transplantation have prompted the growth of NC-NRP procurement for abdominal-only DCD donors across the US, and now requires standardization of technical and nontechnical aspects of this procedure.

审查目的:在美国,常温区域灌注(NRP)是一种用于循环死亡(DCD)后捐献的新型采购技术。该技术由心胸外科项目首创,目前腹腔移植项目正将其应用于腹腔器官捐献者:最近的研究结果:在美国,与心脏超快速恢复(SRR)DCD 供体的受体相比,胸腹腔 NRP(TA-NRP)供体的肝脏和肾脏移植的肾脏移植功能延迟率较低,移植器官和患者存活率相似。摘要:肝脏和肾脏移植的早期疗效极佳,促使全美越来越多地为腹腔DCD供体进行NC-NRP采购,现在需要对这一手术的技术和非技术方面进行标准化。
{"title":"Abdominal normothermic regional perfusion in the United States: current state and future directions.","authors":"Anji Wall, Amar Gupta, Giuliano Testa","doi":"10.1097/MOT.0000000000001144","DOIUrl":"10.1097/MOT.0000000000001144","url":null,"abstract":"<p><strong>Purpose of review: </strong>Normothermic regional perfusion (NRP) is a novel procurement technique for donation after circulatory death (DCD) in the United States. It was pioneered by cardiothoracic surgery programs and is now being applied to abdominal-only organ donors by abdominal transplant programs.</p><p><strong>Recent findings: </strong>Liver and kidney transplantation from thoracoabdominal NRP (TA-NRP) donors in the United States was found to have lower rates of delayed kidney graft function and similar graft and patient survival versus recipients of cardiac super rapid recovery (SRR) DCD donors. The excellent outcomes with NRP have prompted the expansion of NRP technology to abdominal transplant programs.</p><p><strong>Summary: </strong>Excellent early outcomes with liver and kidney transplantation have prompted the growth of NC-NRP procurement for abdominal-only DCD donors across the US, and now requires standardization of technical and nontechnical aspects of this procedure.</p>","PeriodicalId":10900,"journal":{"name":"Current Opinion in Organ Transplantation","volume":null,"pages":null},"PeriodicalIF":2.2,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140173999","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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Current Opinion in Organ Transplantation
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