Nassar Ahmed, Liu Qiang, Farias Kevin, D'Amico Giuseppe, Tom Cynthia, Grady Patrick, Bennett Ana, Diago Uso Teresa, Eghtesad Bijan, Kelly Dympna, Fung John, Abu-Elmagd Kareem, Miller Charles, Quintini Cristiano
Cleveland Clinic, Cleveland, OH, USA.
Case Western Reserve University, Cleveland, OH, USA.
Surg Innov. 2015 Feb;22(1):61-9. doi: 10.1177/1553350614528383. Epub 2014 Apr 2.
Normothermic machine perfusion (NMP) is an emerging preservation modality that holds the potential to prevent the injury associated with low temperature and to promote organ repair that follows ischemic cell damage. While several animal studies have showed its superiority over cold storage (CS), minimal studies in the literature have focused on safety, feasibility, and reliability of this technology, which represent key factors in its implementation into clinical practice. The aim of the present study is to report safety and performance data on NMP of DCD porcine livers.
After 60 minutes of warm ischemia time, 20 pig livers were preserved using either NMP (n = 15; physiologic perfusion temperature) or CS group (n = 5) for a preservation time of 10 hours. Livers were then tested on a transplant simulation model for 24 hours. Machine safety was assessed by measuring system failure events, the ability to monitor perfusion parameters, sterility, and vessel integrity. The ability of the machine to preserve injured organs was assessed by liver function tests, hemodynamic parameters, and histology.
No system failures were recorded. Target hemodynamic parameters were easily achieved and vascular complications were not encountered. Liver function parameters as well as histology showed significant differences between the 2 groups, with NMP livers showing preserved liver function and histological architecture, while CS livers presenting postreperfusion parameters consistent with unrecoverable cell injury.
Our study shows that NMP is safe, reliable, and provides superior graft preservation compared to CS in our DCD porcine model.
常温机器灌注（NMP）是一种新兴的保存方式，有潜力预防与低温相关的损伤，并促进缺血性细胞损伤后的器官修复。虽然多项动物研究已表明其优于冷藏（CS），但文献中极少有研究关注该技术的安全性、可行性和可靠性，而这些是其应用于临床实践的关键因素。本研究的目的是报告脑死亡猪肝脏NMP的安全性和性能数据。
在60分钟热缺血时间后，20个猪肝分别采用NMP（n = 15；生理灌注温度）或CS组（n = 5）保存10小时。然后在移植模拟模型上对肝脏进行24小时测试。通过测量系统故障事件、监测灌注参数的能力、无菌性和血管完整性来评估机器安全性。通过肝功能测试、血流动力学参数和组织学评估机器保存受损器官的能力。
未记录到系统故障。轻松实现了目标血流动力学参数，未遇到血管并发症。两组之间的肝功能参数以及组织学显示出显著差异，NMP肝脏显示肝功能和组织结构得以保存，而CS肝脏呈现出与不可恢复的细胞损伤一致的再灌注参数。
我们的研究表明，在我们的脑死亡猪模型中，NMP是安全、可靠的，并且与CS相比能提供更好的移植物保存效果。
