Kakizaki Y, Miyagi S, Shimizu K, Kumata H, Matsumura M, Miyazaki Y, Fukuoka K, Uematsu S S, Tokodai K, Hara Y, Nakanishi C, Unno M, Kamei T, Goto M
Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Department of Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
Transplant Proc. 2018 Jun;50(5):1538-1543. doi: 10.1016/j.transproceed.2018.02.061. Epub 2018 Apr 25.
Liver transplantation from donors after cardiac death (DCD) provides a solution to the donor shortage. However, DCD liver grafts are associated with a high incidence of primary graft nonfunction. We investigated the effectiveness of subnormothermic porcine liver perfusion, before transplantation from DCD, on graft viability.
Landrace pigs (25-30 kg) were randomly allocated to 3 groups (5 per group): heart-beating (HB) graft, transplanted after a 4-hour period of cold storage (CS); DCD graft, retrieved 20 minutes after apnea-induced cardiac arrest (respiratory withdrawal) and transplanted after a 4-hour period of CS; and subnormothermic ex vivo liver perfusion (SELP) graft, retrieved in the same manner as the DCD graft but perfused with a subnormothermic oxygenated Krebs-Henseleit buffer (21-25°C, 10-15 cm HO) for 30 minutes in a simplified dripping manner, without a machine perfusion system, after the 4-hour period of CS, and subsequently transplanted.
Although all animals in the HB group survived for >7 days, all animals in the DCD group died within 12 hours after transplantation. In the SELP group, 2 recipients survived for >7 days and another 2 recipients were killed on day 5. The survival rate was significantly better for SELP than for DCD grafts (P = .0016). The values of tumor necrosis factor α were not significantly different between the SELP and HB groups. Preserved structure of the parenchyma was observed in the SELP group on histologic examination.
A simplified subnormothermic perfusion before liver transplantation is expected to improve graft viability and survival.
心脏死亡后供体肝脏移植（DCD）为供体短缺问题提供了一种解决方案。然而，DCD肝移植与原发性移植肝功能衰竭的高发生率相关。我们研究了在DCD肝移植前进行亚低温猪肝灌注对移植物存活的有效性。
将长白猪（25 - 30千克）随机分为3组（每组5只）：心跳供体（HB）移植物组，在4小时冷保存（CS）后进行移植；DCD移植物组，在呼吸停止诱导的心脏骤停（呼吸撤离）20分钟后获取移植物，并在4小时CS后进行移植；亚低温体外肝脏灌注（SELP）移植物组，获取方式与DCD移植物组相同，但在4小时CS后，以简化的滴注方式，在无机器灌注系统的情况下，用亚低温含氧的克雷布斯 - 亨塞尔特缓冲液（21 - 25°C，10 - 15厘米水柱）灌注30分钟，随后进行移植。
虽然HB组的所有动物存活超过7天，但DCD组的所有动物在移植后12小时内死亡。在SELP组中，2只受体存活超过7天，另外2只受体在第5天被处死。SELP组的存活率明显高于DCD移植物组（P = 0.0016）。SELP组和HB组之间肿瘤坏死因子α的值无显著差异。组织学检查显示SELP组实质结构保存良好。
肝移植前进行简化的亚低温灌注有望提高移植物的存活能力和生存率。
