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 Current Opinion in Organ 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
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引用次数: 0

摘要

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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Viability assessment of the liver during ex-situ machine perfusion prior to transplantation.

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.

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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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