Watson Christopher J E, Jochmans Ina
1Department of Surgery, University of Cambridge School of Clinical Medicine, Cambridge, UK.
2The National Institute of Health Research (NIHR) Cambridge Biomedical Research Centre and the NIHR Blood and Transplant Research Unit (BTRU) at the University of Cambridge in collaboration with Newcastle University and in partnership with NHS Blood and Transplant (NHSBT), Cambridge, UK.
Curr Transplant Rep. 2018;5(1):72-81. doi: 10.1007/s40472-018-0178-9. Epub 2018 Jan 20.
The purpose of this review was to summarise how machine perfusion could contribute to viability assessment of donor livers.
In both hypothermic and normothermic machine perfusion, perfusate transaminase measurement has allowed pretransplant assessment of hepatocellular damage. Hypothermic perfusion permits transplantation of marginal grafts but as yet has not permitted formal viability assessment. Livers undergoing normothermic perfusion have been investigated using parameters similar to those used to evaluate the liver in vivo. Lactate clearance, glucose evolution and pH regulation during normothermic perfusion seem promising measures of viability. In addition, bile chemistry might inform on cholangiocyte viability and the likelihood of post-transplant cholangiopathy.
While the use of machine perfusion technology has the potential to reduce and even remove uncertainty regarding liver graft viability, analysis of large datasets, such as those derived from large multicenter trials of machine perfusion, are needed to provide sufficient information to enable viability parameters to be defined and validated .
本综述旨在总结机器灌注如何有助于评估供肝的活力。
在低温和常温机器灌注中，通过测量灌注液中的转氨酶可在移植前评估肝细胞损伤情况。低温灌注允许边缘供肝进行移植，但尚未能进行正式的活力评估。对进行常温灌注的肝脏，已采用与体内评估肝脏时类似的参数进行研究。常温灌注期间的乳酸清除率、葡萄糖生成及pH调节似乎是很有前景的活力评估指标。此外，胆汁化学指标可能有助于了解胆管细胞的活力及移植后发生胆管病变的可能性。
虽然机器灌注技术有可能减少甚至消除关于肝移植活力的不确定性，但需要分析大型数据集，比如来自机器灌注大型多中心试验的数据集，以提供足够信息来定义和验证活力参数。
