Shigeta T, Matsuno N, Obara H, Mizunuma H, Kanazawa H, Tanaka H, Fukuda A, Sakamoto S, Kasahara M, Uemoto S, Enosawa S
National Center for Child Health and Development, Tokyo, Japan.
Transplant Proc. 2012 May;44(4):946-7. doi: 10.1016/j.transproceed.2012.01.078.
Grafts from donation after cardiac death (DCD) will greatly contribute to the expand the donor pool. However, these grafts may require the development of the preservation methods because of primary nonfunction and severe ischemic bile duct injury.
Porcine livers were perfused with a newly developed machine perfusion (MP) system. Each system for the portal vein or the hepatic artery had a roller pump, a flow meter, and a pressure sensor. The livers were perfused with University of Wisconsin (UW)-gluconate at 4°C-6°C for 3 hours after 2 hours simple cold storage (CS). The portal vein flow rate was 0.5 mL/min/g liver (pressure, 10 mm Hg) and the hepatic artery flow rate was 0.2 mL/min/g liver (pressure, 30 mm Hg). Orthotopic liver transplantation was performed in pigs comparing Group 1 (n = 4) procured after acute hemorrhagic shock preserved by MP, Group 2 (n = 3) procured after warm ischemia time (WIT) of 30 minutes with CS preservation, and Group 3 (n = 4) procured with 30 minutes of WIT and MP preservation.
Collected effluent aspartate aminotransferase (AST) and lactate dehydrogenase (LDH) levels in the perfusion solution and serum AST and LDH were significantly lower in Group 1. AST and LDH results were lower in Group 3 than Group 2. Survival rates in Groups 1 and 3 were 3/4, but 0/3 in Group 2.
MP preservation was a useful promising preservation mode for DCD liver grafts.
心脏死亡后捐赠（DCD）的移植物将极大地有助于扩大供体库。然而，由于原发性无功能和严重的缺血性胆管损伤，这些移植物可能需要开发保存方法。
用新开发的机器灌注（MP）系统对猪肝进行灌注。门静脉或肝动脉的每个系统都有一个滚轴泵、一个流量计和一个压力传感器。在简单冷藏（CS）2小时后，将肝脏在4°C - 6°C下用威斯康星大学（UW）-葡萄糖酸盐灌注3小时。门静脉流速为0.5 mL/min/g肝脏（压力，10 mmHg），肝动脉流速为0.2 mL/min/g肝脏（压力，30 mmHg）。对猪进行原位肝移植，比较第1组（n = 4），通过MP保存，在急性失血性休克后获取；第2组（n = 3），在30分钟热缺血时间（WIT）后通过CS保存获取；第3组（n = 4），在30分钟WIT后通过MP保存获取。
第1组灌注液中收集的流出液天冬氨酸转氨酶（AST）和乳酸脱氢酶（LDH）水平以及血清AST和LDH水平显著较低。第3组的AST和LDH结果低于第2组。第1组和第3组的存活率为3/4，但第2组为0/3。
MP保存是DCD肝移植物一种有用且有前景的保存模式。
