概念验证：常温机器灌注期间的肝脏劈离
Proof of concept: liver splitting during normothermic machine perfusion.
作者信息
Stephenson Barney T F, Bonney Glenn K, Laing Richard W, Bhogal Ricky H, Marcon Francesca, Neil Desley A H, Perera M Thamara P R, Afford Simon C, Mergental Hynek, Mirza Darius F
机构信息
NIHR Birmingham Liver Biomedical Research Unit and Centre for Liver Research, University of Birmingham, Edgbaston, Birmingham B15 2TT, UK.
The Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2GW, UK.
出版信息
J Surg Case Rep. 2018 Mar 28;2018(3):rjx218. doi: 10.1093/jscr/rjx218. eCollection 2018 Mar.
INTRODUCTION
Despite utilizing extended criteria donors, there remains a shortage of livers for transplantation. No data exists on splitting donor livers with concurrent NMP-L.
METHODS
A liver recovered from a donor after circulatory death was subjected to NMP-L using a red cell based fluid. During NMP-L, a 'classical' left lateral + right trisegmentectomy split was performed using an integrated bipolar/ultrasonic device. After splitting, blood flow was confirmed using Doppler ultrasound in each lobe.
RESULTS
Prior to splitting, flow rates were maintained physiologically. Lactate decreased from 13.9 to 3.0 mmol/L. Lactate before and after splitting were similar in the hepatic arteries, portal veins and IVC. Doppler ultrasound demonstrated arterial and venous waveforms in both lobes after splitting.
CONCLUSIONS
'Classical' liver splitting during NMP-L is feasible, maintaining viability of both lobes. Establishing this procedure may attenuate cold ischaemic injury, allow pre-implantation monitoring of both grafts and facilitate logistics of transplanting two grafts.
引言
尽管使用了边缘供体，但肝脏移植供体仍然短缺。目前尚无关于在体外常温机器灌注保存（NMP-L）的同时分割供体肝脏的数据。
方法
使用基于红细胞的液体对一名循环性死亡供体的肝脏进行体外常温机器灌注保存。在体外常温机器灌注保存过程中，使用集成双极/超声设备进行“经典”的左外叶+右三段切除术分割。分割后，使用多普勒超声确认每个肝叶的血流情况。
结果
分割前，血流速率维持在生理水平。乳酸水平从13.9 mmol/L降至3.0 mmol/L。肝动脉、门静脉和下腔静脉分割前后的乳酸水平相似。多普勒超声显示分割后两个肝叶均有动脉和静脉波形。
结论
在体外常温机器灌注保存期间进行“经典”肝脏分割是可行的，可维持两个肝叶的活力。建立该程序可能会减轻冷缺血损伤，允许对两个移植物进行植入前监测，并便于两个移植物移植的后勤工作。
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