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 Current Opinion in Organ 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
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引用次数: 0

摘要

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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Machine perfusion in liver transplantation: recent advances and coming challenges.

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.

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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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