肝脏机械灌注：过去、现在和未来。
Machine perfusion of the liver: past, present and future.
机构信息
Department of Abdominal Transplant Surgery and Transplant Coordination, University Hospitals Leuven, Catholic University Leuven, Leuven, Belgium.
出版信息
Curr Opin Organ Transplant. 2010 Apr;15(2):160-6. doi: 10.1097/MOT.0b013e328337342b.
PURPOSE OF REVIEW
This review considers the potential of machine perfusion to preserve livers for clinical transplantation, including steatotic or ischaemically damaged grafts and aims to go over the most significant achievements in liver machine perfusion over the last year. To reach acceptance in liver preservation, machine perfusion will need to improve outcomes compared with simple cold storage (SCS), provide objective measures of graft viability, and resuscitate less-than-ideal grafts before transplantation.
RECENT FINDINGS
Current machine perfusion protocols comprise both hypothermic (HMP) and normothermic (NMP) approaches. HMP increases energy stores compared to SCS, and NMP shows additional resuscitative potential. Dutkowski transplanted ischaemically damaged pig livers after HMP following SCS, which avoided graft failure observed after SCS alone. Guarrera performed 20 clinical transplants after 4-7 h HMP. Friend has performed porcine transplantations after NMP of 4-20 h and univocally demonstrated the significant resuscitative effects on ischaemically damaged grafts otherwise destined to fail. Whereas NMP promises resuscitative effects, it demands challenging, near-physiologic conditions. Subnormothermic perfusion is being tested as a promising medium in between.
SUMMARY
Despite recent substantial improvements, liver preservation by machine perfusion remains limited and in contrast to the global revival of kidney machine perfusion. However, liver machine perfusion may be close to returning to clinical practice if it has not already done so. History shows that superiority alone does not guarantee immediate clinical use. Further clear-cut benefits of machine perfusion such as viability assessment will have to be accompanied by usability and human factors, and innovative and improved perfusion solutions applied in novel perfusion protocols.
目的综述
本综述探讨了机器灌注在临床肝移植中的应用潜力，包括脂肪肝或缺血性损伤供肝，并旨在回顾过去一年中肝机器灌注的主要进展。为了在肝保存中得到认可，机器灌注需要比单纯冷保存（SCS）改善结果，提供供体活力的客观指标，并在移植前复苏不太理想的供体。
最新发现
目前的机器灌注方案包括低温（HMP）和常温（NMP）方法。与 SCS 相比，HMP 增加了能量储备，而 NMP 显示出额外的复苏潜力。Dutkowski 在 SCS 后进行 HMP 治疗缺血性损伤的猪肝移植，避免了单独使用 SCS 后观察到的移植失败。Guarrera 进行了 20 例 HMP 4-7 小时后的临床移植。Friend 进行了 NMP 4-20 小时的猪移植，并一致证明了对缺血性损伤供体的显著复苏作用，否则这些供体注定会失败。虽然 NMP 有复苏作用，但它需要具有挑战性的、接近生理的条件。亚低温灌注正在作为一种有前途的中间介质进行测试。
总结
尽管最近取得了实质性的进展，但机器灌注保存肝脏的应用仍然有限，与全球肾脏机器灌注的复苏形成对比。然而，如果机器灌注还没有恢复到临床实践中，它可能已经接近了。历史表明，优越性本身并不能保证立即临床应用。机器灌注的进一步明确优势，如活力评估，将必须伴随着可用性和人为因素，以及在新的灌注方案中应用创新和改进的灌注解决方案。
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