Centre Hépatobiliaire, Paul Brousse Hospital, Villejuif, France.
Institut National de la Santé et de la Recherche (INSERM) Unité 935, Villejuif, France.
Clin Transplant. 2018 Jun;32(6):e13256. doi: 10.1111/ctr.13256. Epub 2018 May 7.
Many factors may compromise the functional recovery of a harvested potential liver for engraftment. Normothermic machine perfusion (NMP) can revive hepatic metabolism ex vivo enabling subsequent transplantation. In this study, we evaluated the recovery of 11 discarded livers' function utilizing NMP.
Eleven consecutive discarded livers underwent NMP for 6 hours. Liver function recovery was defined by lactate levels of ≤3 mmol/L and continuous bile production.
Ten of 11 livers perfused were fatty. The median percentage of macrosteatosis (MaS) and microsteatosis (MiS) was 40% (10%-90%) and 40% (20%-50%), respectively, based on a review of paraffin-embedded sections of preperfusion biopsies. A discarded "amyloid" liver from an HIV-positive donor was also studied. Recovery of liver function was observed in 4 livers, including that with the amyloid deposition. These livers sustained shorter cold ischemia times and seemed to have increased portal and arterial blood flow. No significant change in MiS or MaS was observed before and after perfusion.
Our results suggest that some discarded grafts might have been salvaged for transplantation. Further studies utilizing NMP with subsequent transplantation would validate this strategy.
许多因素可能会影响已获取的潜在供肝用于移植后的功能恢复。常温机器灌注（NMP）可在体外恢复肝脏代谢，从而实现后续移植。在这项研究中，我们评估了利用 NMP 恢复 11 个废弃肝脏功能的效果。
连续 11 个废弃肝脏接受了 6 小时的 NMP。通过乳酸水平≤3mmol/L 和持续胆汁生成来定义肝脏功能的恢复。
灌注的 11 个肝脏中有 10 个为脂肪性肝脏。基于对预灌注活检石蜡包埋切片的评估，宏观脂肪变性（MaS）和微观脂肪变性（MiS）的中位数分别为 40%（10%-90%）和 40%（20%-50%）。还研究了来自 HIV 阳性供体的废弃“淀粉样变性”肝脏。4 个肝脏观察到了肝功能的恢复，包括淀粉样变性的肝脏。这些肝脏的冷缺血时间较短，门静脉和肝动脉血流似乎增加。灌注前后 MiS 或 MaS 没有明显变化。
我们的结果表明，一些废弃的移植物可能已经被挽救用于移植。进一步利用 NMP 进行后续移植的研究将验证这一策略。
