Brüggenwirth Isabel M A, Moore Carolina, Mahboub Paria, Thijssen Max F, E Xiaofei, Leuvenink Henri G D, Mandrekar Pranoti, Wang Xiaofei, Kowalik Timothy F, Porte Robert J, Martins Paulo N
Division of Organ Transplantation, Department of Surgery, UMass Memorial Medical Center, University of Massachusetts, Worcester, MA.
Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Transplant Direct. 2018 Oct 23;4(11):e400. doi: 10.1097/TXD.0000000000000840. eCollection 2018 Nov.
It remains controversial if arterial perfusion in addition to portal vein perfusion during machine preservation improves liver graft quality. Comparative studies using both techniques are lacking. We studied the impact of using single or dual machine perfusion of donation after circulatory death rat livers. In addition, we analyzed the effect of pulsatile versus continuous arterial flow.
Donation after circulatory death rat livers (n = 18) were preserved by 6 hours cold storage, followed by 1 hour subnormothermic machine perfusion (20°C, pressure of 40/5 mm Hg) and 2 hours ex vivo warm reperfusion (37°C, pressure of 80/11 mm Hg, 9% whole blood). Machine preservation was either through single portal vein perfusion (SP), dual pulsatile (DPP), or dual continuous perfusion (DCP) of the portal vein and hepatic artery. Hydrodynamics, liver function tests, histopathology, and expression of endothelial specific genes were assessed during 2 hours warm reperfusion.
At the end of reperfusion, arterial flow in DPP livers tended to be higher compared to DCP and SP grafts. However, this difference was not significant nor was better flow associated with better outcome. No differences in bile production or alanine aminotransferase levels were observed. SP livers had significantly lower lactate compared to DCP, but not DPP livers. Levels of Caspase-3 and tumor necrosis factor-α were similar between the groups. Expression of endothelial genes Krüppel-like-factor 2 and endothelial nitric oxide synthase tended to be higher in dual perfused livers, but no histological evidence of better preservation of the biliary endothelium or vasculature of the hepatic artery was observed.
This study shows comparable outcomes after using a dual or single perfusion approach during end-ischemic subnormothermic liver machine preservation.
在机器保存期间，除门静脉灌注外进行动脉灌注是否能改善肝移植质量仍存在争议。缺乏对这两种技术的比较研究。我们研究了使用单台或双台机器灌注脑死亡大鼠肝脏的影响。此外，我们分析了搏动性与连续性动脉血流的效果。
脑死亡大鼠肝脏（n = 18）经6小时冷保存，随后进行1小时亚低温机器灌注（20°C，压力40/5 mmHg）和2小时体外温再灌注（37°C，压力80/11 mmHg，9%全血）。机器保存通过门静脉的单灌注（SP）、双搏动灌注（DPP）或门静脉和肝动脉的双连续灌注（DCP）进行。在2小时温再灌注期间评估流体动力学、肝功能测试、组织病理学和内皮特异性基因的表达。
再灌注结束时，DPP组肝脏的动脉血流相较于DCP组和SP组有升高趋势。然而，这种差异并不显著，且较好的血流与较好的结果无关。胆汁生成或丙氨酸转氨酶水平未见差异。与DCP组相比，SP组肝脏的乳酸水平显著较低，但与DPP组相比无差异。各组间Caspase-3和肿瘤坏死因子-α水平相似。双灌注肝脏中内皮基因Krüppel样因子2和内皮型一氧化氮合酶的表达有升高趋势，但未观察到胆管内皮或肝动脉血管保存更好的组织学证据。
本研究表明，在缺血末期亚低温肝脏机器保存期间，使用双灌注或单灌注方法后的结果相当。
