Voigt Marcia R, DeLario Ginger T
Carolina Donor Services, Durham, North Carolina.
Prog Transplant. 2013 Dec;23(4):383-91. doi: 10.7182/pit2013100.
Various preservation solutions are used for kidney, liver, pancreas, small intestine, and multiorgan recoveries and transplants. The effectiveness of these solutions, primarily measured by ability to preserve the organ and graft survival, was analyzed. The 2 most common solutions used for intra-abdominal organs are University of Wisconsin Solution (UW)/Viaspan and Histidine-tryptophan-ketoglutarate (HTK)/Custodiol solution. Outcomes for liver, pancreas, and kidney allografts preserved with these 2 solutions are similar. Although HTK solution shows conflicting results with respect to pancreatic cellular edema, researchers in several studies have noted that HTK solution may be more protective than UW solution against biliary complications in liver transplant. In kidney recoveries, HTK solution may be associated with higher graft loss and increased delayed graft function in marginal deceased donors but had lower incidence of delayed graft function in living donors when compared with UW. UW remains the reference standard for use during multiorgan recoveries but is experiencing strong competition from HTK and other alternative solutions. Some researchers suggest that Celsior's comparable results in abdominal organs and viability for thoracic organs makes it a strong competitor, especially in multiorgan recoveries. Each solution has benefits accompanied by disadvantages. Although it may not be feasible, when considering single-organ recoveries, consideration of alternative solutions may be warranted.
各种保存液用于肾脏、肝脏、胰腺、小肠及多器官的获取与移植。分析了这些保存液的有效性,主要通过保存器官的能力和移植物存活情况来衡量。用于腹腔内器官的两种最常用的保存液是威斯康星大学保存液(UW)/维司潘和组氨酸-色氨酸-酮戊二酸(HTK)/康斯迪欧溶液。用这两种保存液保存的肝、胰和肾同种异体移植物的结果相似。尽管HTK溶液在胰腺细胞水肿方面显示出相互矛盾的结果,但多项研究的研究者指出,在肝移植中,HTK溶液可能比UW溶液对胆道并发症更具保护作用。在肾脏获取中,与UW相比,HTK溶液可能与边缘性脑死亡供体的移植物丢失率较高及移植肾功能延迟发生率增加有关,但在活体供体中移植肾功能延迟的发生率较低。UW仍然是多器官获取时使用的参考标准,但正面临来自HTK和其他替代溶液的激烈竞争。一些研究者认为,赛尔西奥保存液在腹腔器官方面的类似结果以及在胸腔器官方面的活力使其成为一个强有力的竞争者,尤其是在多器官获取中。每种溶液都有其优缺点。虽然在考虑单器官获取时可能不可行,但考虑使用替代溶液可能是有必要的。