肝移植的常温机器灌注:现状与未来方向。

IF 1.8 4区 医学 Q3 TRANSPLANTATION Current Opinion in Organ Transplantation Pub Date : 2024-06-01 Epub Date: 2024-03-14 DOI:10.1097/MOT.0000000000001141
Jessica Lindemann, Jennifer Yu, Mb Majella Doyle
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引用次数: 0

摘要

审查目的:肝移植等待名单上的患者人数不断增加,远远超过了可供移植的肝脏数量。常温机器灌注(NMP)允许在生理条件下进行体外灌注,有可能显著提高器官产量并扩大捐献者库:最近的研究结果:多项研究发现,随着 NMP 的实施,心脏死亡后捐献的利用率增加,脑死亡捐献者肝脏的标准也有所提高,这主要归功于在机器灌注过程中进行存活率测试的能力。最近提出的存活标准包括乳酸清除率、维持灌注液 pH 值大于 7.2、ALT 小于 6000 u/l、葡萄糖代谢和胆汁生成的证据。在 NMP 期间优化肝脏移植物是一个活跃的研究领域,包括对脂肪肝进行脱脂、预防缺血性胆管病变和排斥反应以及最大限度地减少缺血再灌注损伤等干预措施。延长器官储存时间增加了灵活性,有可能改善时间限制和移植物流。有必要进一步研究确定理想的存活标准,并探讨如何在NMP期间优化边缘和无法移植的肝脏移植物。
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Normothermic machine perfusion for liver transplantation: current state and future directions.

Purpose of review: The number of patients on the liver transplant waitlist continues to grow and far exceeds the number of livers available for transplantation. Normothermic machine perfusion (NMP) allows for ex-vivo perfusion under physiologic conditions with the potential to significantly increase organ yield and expand the donor pool.

Recent findings: Several studies have found increased utilization of donation after cardiac death and extended criteria brain-dead donor livers with implementation of NMP, largely due to the ability to perform viability testing during machine perfusion. Recently, proposed viability criteria include lactate clearance, maintenance of perfusate pH more than 7.2, ALT less than 6000 u/l, evidence of glucose metabolism and bile production. Optimization of liver grafts during NMP is an active area of research and includes interventions for defatting steatotic livers, preventing ischemic cholangiopathy and rejection, and minimizing ischemia reperfusion injury.

Summary: NMP has resulted in increased organ utilization from marginal donors with acceptable outcomes. The added flexibility of prolonged organ storage times has the potential to improve time constraints and transplant logistics. Further research to determine ideal viability criteria and investigate ways to optimize marginal and otherwise nontransplantable liver grafts during NMP is warranted.

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来源期刊
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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