Department of Surgery, Center for Engineering in Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA; Department of Surgery (Surgical Laboratory), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
Am J Transplant. 2014 Jun;14(6):1400-9. doi: 10.1111/ajt.12727. Epub 2014 Apr 23.
To reduce widespread shortages, attempts are made to use more marginal livers for transplantation. Many of these grafts are discarded for fear of inferior survival rates or biliary complications. Recent advances in organ preservation have shown that ex vivo subnormothermic machine perfusion has the potential to improve preservation and recover marginal livers pretransplantation. To determine the feasibility in human livers, we assessed the effect of 3 h of oxygenated subnormothermic machine perfusion (21°C) on seven livers discarded for transplantation. Biochemical and microscopic assessment revealed minimal injury sustained during perfusion. Improved oxygen uptake (1.30 [1.11-1.94] to 6.74 [4.15-8.16] mL O2 /min kg liver), lactate levels (4.04 [3.70-5.99] to 2.29 [1.20-3.43] mmol/L) and adenosine triphosphate content (45.0 [70.6-87.5] pmol/mg preperfusion to 167.5 [151.5-237.2] pmol/mg after perfusion) were observed. Liver function, reflected by urea, albumin and bile production, was seen during perfusion. Bile production increased and the composition of bile (bile salts/phospholipid ratio, pH and bicarbonate concentration) became more favorable. In conclusion, ex vivo subnormothermic machine perfusion effectively maintains liver function with minimal injury and sustains or improves various hepatobiliary parameters postischemia.
为了减少广泛的短缺，人们试图使用更多边缘肝脏进行移植。由于担心存活率较低或胆道并发症，许多这些移植物被丢弃。最近器官保存方面的进展表明，离体亚低温机器灌注具有改善保存和恢复移植前边缘肝脏的潜力。为了确定在人类肝脏中的可行性，我们评估了在为移植而丢弃的七例肝脏中进行 3 小时充氧亚低温机器灌注（21°C）的效果。生化和显微镜评估显示，在灌注过程中仅受到最小的损伤。氧摄取量（1.30 [1.11-1.94]增加到 6.74 [4.15-8.16] mL O2 / min kg 肝脏）、乳酸水平（4.04 [3.70-5.99]降低到 2.29 [1.20-3.43] mmol/L）和三磷酸腺苷含量（45.0 [70.6-87.5] pmol/mg 灌注前增加到 167.5 [151.5-237.2] pmol/mg 灌注后）都得到了改善。在灌注过程中观察到肝功能，反映在尿素、白蛋白和胆汁生成上。胆汁生成增加，胆汁成分（胆汁盐/磷脂比、pH 值和碳酸氢盐浓度）变得更加有利。总之，离体亚低温机器灌注可有效维持肝功能，损伤最小，并在缺血后维持或改善各种肝胆参数。
