Hameed Ahmer M, Wong Germaine, Laurence Jerome M, Lam Vincent W T, Pleass Henry C, Hawthorne Wayne J
Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
HPB (Oxford). 2017 Nov;19(11):933-943. doi: 10.1016/j.hpb.2017.07.012. Epub 2017 Aug 24.
This study aimed to identify the most effective solution for in situ perfusion/preservation of the pancreas in donation after brain death donors, in addition to optimal in situ flush volume(s) and route(s) during pancreas procurement.
Embase, Medline and Cochrane databases were utilized (1980-2017). Articles comparing graft outcomes between two or more different perfusion/preservation fluids (University of Wisconsin (UW), histidine-tryptophan-ketoglutarate (HTK) and/or Celsior) were compared using random effects models where appropriate.
Thirteen articles were included (939 transplants). Confidence in available evidence was low. A higher serum peak lipase (standardized mean difference 0.47, 95% CI 0.23-0.71, I = 0) was observed in pancreatic grafts perfused/preserved with HTK compared to UW, but there were no differences in one-month pancreas allograft survivals or early thrombotic graft loss rates. Similarly, there were no significant differences in the rates of graft pancreatitis, thrombosis and graft survival between UW and Celsior solutions, and between aortic-only and dual aorto-portal perfusion.
UW cold perfusion may reduce peak serum lipase, but no quality evidence suggested UW cold perfusion improves graft survival and reduces thrombosis rates. Further research is needed to establish longer-term graft outcomes, the comparative efficacy of Celsior, and ideal perfusion volumes.
本研究旨在确定脑死亡供体胰腺原位灌注/保存的最有效方案，以及胰腺获取过程中的最佳原位冲洗量和冲洗途径。
利用Embase、Medline和Cochrane数据库（1980 - 2017年）。在适当情况下，使用随机效应模型比较两篇或更多不同灌注/保存液（威斯康星大学（UW）液、组氨酸-色氨酸-酮戊二酸（HTK）液和/或赛尔西奥液）之间移植物结局的文章。
纳入13篇文章（939例移植）。现有证据的可信度较低。与UW液相比，用HTK液灌注/保存的胰腺移植物中观察到更高的血清峰值脂肪酶（标准化均数差值0.47，95%可信区间0.23 - 0.71，I² = 0），但在1个月胰腺同种异体移植物存活率或早期血栓形成性移植物丢失率方面没有差异。同样，UW液和赛尔西奥液之间，以及仅主动脉灌注和主动脉-门静脉双灌注之间，在移植物胰腺炎、血栓形成和移植物存活率方面没有显著差异。
UW冷灌注可能降低血清峰值脂肪酶，但没有高质量证据表明UW冷灌注能提高移植物存活率并降低血栓形成率。需要进一步研究以确定长期移植物结局、赛尔西奥液的比较疗效以及理想的灌注量。
