Shigeta T, Matsuno N, Obara H, Kanazawa H, Tanaka H, Fukuda A, Sakamoto S, Kasahara M, Mizunuma H, Enosawa S
National Center for Child Health and Development, Transplantation Center, Division for Advanced Medical Sciences, Tokyo, Japan.
Transplant Proc. 2013 Jun;45(5):1684-9. doi: 10.1016/j.transproceed.2013.01.098.
Utilization of grafts from donors after cardiac death (DCD) greatly expands the organ pool. However, implementation of such a strategy requires the development of novel preservation methods to achieve recovery from changes owing to warm ischemia.
To assess potential methods, porcine livers harvested after 60 minutes of warm ischemic time (WIT) were perfused and preserved under the following conditions: Group 1 (n = 3), 2-hour simple cold storage and 2-hour machine perfusion (MP) at 8°C; group 2 (n = 3), 2 hours at 25°C and MP at 25°C and group 3 (n = 3), 2-hour simple cold storage and gradual rewarming to 25°C by MP. The preserved liver grafts were transplanted orthotopically into recipients.
The aspartate aminotransferase (AST), lactate dehydrogenase (LDH), and hyaluronic acid (HA) levels in recipient blood at 2 hours after reperfusion were significantly lower among group 3: AST, 789 ± 258.8, 1203 ± 217.0, and 421 ± 55.8 IU/L; LDH, 1417 ± 671.2, 2132 ± 483.9, and 634 ± 263.9 IU/L; and HA, 1660 ± 556.5, 1463 ± 332.3, and 575 ± 239.0 ng/mL for groups 1, 2 and 3, respectively. Histologically, necrosis and swelling of hepatocytes were less severe among group 3 than groups 1 and 2. Group 3 animals showed better vital responses and started spontaneous breathing within 2 hours after reperfusion; 1 recipient survived for >24 hours, although all animals in groups 1 and 2 died within 2 to 3 hours after reperfusion.
Rewarming by MP preservation may facilitate recovery and resuscitation of DCD liver grafts.
利用心脏死亡后供体（DCD）的移植物可极大地扩充器官库。然而，实施这样一种策略需要开发新的保存方法，以从因热缺血导致的变化中恢复过来。
为评估潜在方法，对热缺血时间（WIT）达60分钟后获取的猪肝在以下条件下进行灌注和保存：第1组（n = 3），2小时简单冷藏并在8°C进行2小时机器灌注（MP）；第2组（n = 3），在25°C保存2小时并在25°C进行MP；第3组（n = 3），2小时简单冷藏并通过MP逐渐复温至25°C。将保存的肝移植物原位移植到受体中。
再灌注后2小时，第3组受体血液中的天冬氨酸转氨酶（AST）、乳酸脱氢酶（LDH）和透明质酸（HA）水平显著更低：第1组、第2组和第3组的AST分别为789 ± 258.8、1203 ± 217.0和421 ± 55.8 IU/L；LDH分别为1417 ± 671.2、2132 ± 483.9和634 ± 263.9 IU/L；HA分别为1660 ± 556.5、1 / 463 ± 332.3和575 ± 239.0 ng/mL。组织学上，第3组肝细胞的坏死和肿胀比第1组和第2组轻。第3组动物表现出更好的生命反应，再灌注后2小时内开始自主呼吸；1只受体存活超过24小时，而第1组和第2组的所有动物在再灌注后2至3小时内死亡。
通过MP保存进行复温可能有助于DCD肝移植物的恢复和复苏。
