肝脏灌注机的黎明。
The dawn of liver perfusion machines.
机构信息
Division of Transplant Surgery, Massachusetts General Hospital, Boston, Massachusetts, USA.
出版信息
Curr Opin Organ Transplant. 2018 Apr;23(2):151-161. doi: 10.1097/MOT.0000000000000500.
PURPOSE OF REVIEW
Despite high demand, a severe shortage of suitable allografts limits the use of liver transplantation for the treatment of end-stage liver disease. The transplant community is turning to the utilization of high-risk grafts to fill the void. This review summarizes the reemergence of ex-vivo machine perfusion for liver graft preservation, including results of recent clinical trials and its specific role for reconditioning DCD, steatotic and elderly grafts.
RECENT FINDINGS
Several phase-1 clinical trials demonstrate the safety and feasibility of machine perfusion for liver graft preservation. Machine perfusion has several advantages compared with static cold storage and may provide superior transplantation outcomes, particularly for marginal grafts. Ongoing multicenter trials aim to confirm the results of preclinical and pilot studies and establish the clinical utility of ex-vivo liver machine perfusion.
SUMMARY
Mounting evidence supports the benefits of machine perfusion for preservation of liver grafts. Thus, machine perfusion is a promising strategy to expand the donor pool by reconditioning and assessing viability of DCD, elderly and steatotic grafts during the preservation period. Additionally, machine perfusion will serve as a platform to facilitate graft intervention and modification to further optimize marginal grafts.
目的综述
尽管需求很高，但合适的同种异体移植物严重短缺，限制了肝移植治疗终末期肝病的应用。移植界正在转向利用高危移植物来填补这一空白。本综述总结了体外机器灌注在肝脏保存中的重新应用，包括最近临床试验的结果及其在再处理 DCD、脂肪变性和老年供体移植物方面的具体作用。
最近的发现
几项 1 期临床试验证明了机器灌注用于肝脏保存的安全性和可行性。与静态冷藏相比，机器灌注具有许多优势，可能为边缘供体提供更好的移植结果。正在进行的多中心试验旨在证实临床前和试验性研究的结果，并确定体外肝脏机器灌注的临床应用。
总结
越来越多的证据支持机器灌注在保存肝脏移植物方面的益处。因此，机器灌注是一种很有前途的策略，可以通过在保存期间对 DCD、老年和脂肪变性供体进行再处理和评估活力，扩大供体库。此外，机器灌注将作为一个平台，促进移植干预和修饰，以进一步优化边缘供体。
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