Hamar Matyas, Selzner Markus
Multi Organ Transplant Program, Department of Surgery, Toronto General Hospital, Ontario, Canada.
Curr Opin Organ Transplant. 2018 Jun;23(3):369-374. doi: 10.1097/MOT.0000000000000524.
Machine perfusion is a novel strategy to decrease preservation injury, improve graft assessment, and increase organ acceptance for transplantation. This review summarizes the current advances in ex-vivo machine-based kidney preservation technologies over the last year.
Ex-vivo perfusion technologies, such as hypothermic and normothermic machine perfusion and controlled oxygenated rewarming, have gained high interest in the field of organ preservation. Keeping kidney grafts functionally and metabolically active during the preservation period offers a unique chance for viability assessment, reconditioning, and organ repair. Normothermic ex-vivo kidney perfusion has been recently translated into clinical practice. Preclinical results suggest that prolonged warm perfusion appears superior than a brief end-ischemic reconditioning in terms of renal function and injury. An established standardized protocol for continuous warm perfusion is still not available for human grafts.
Ex-vivo machine perfusion represents a superior organ preservation method over static cold storage. There is still an urgent need for the optimization of the perfusion fluid and machine technology and to identify the optimal indication in kidney transplantation. Recent research is focusing on graft assessment and therapeutic strategies.
机器灌注是一种新型策略，可减少保存损伤、改善移植物评估并提高器官移植的接受率。本综述总结了过去一年基于机器的离体肾脏保存技术的当前进展。
诸如低温和常温机器灌注以及控制性氧合复温等离体灌注技术在器官保存领域引起了高度关注。在保存期间保持肾移植功能和代谢活性为活力评估、修复和器官修复提供了独特的机会。常温离体肾脏灌注最近已应用于临床实践。临床前结果表明，就肾功能和损伤而言，延长的温热灌注似乎优于短暂的缺血后修复。目前仍没有适用于人体移植物的既定连续温热灌注标准化方案。
与静态冷藏相比，离体机器灌注是一种更优的器官保存方法。仍然迫切需要优化灌注液和机器技术，并确定肾移植的最佳适应症。近期研究集中在移植物评估和治疗策略上。
