Dondossola D, Lonati C, Zanella A, Maggioni M, Antonelli B, Reggiani P, Gatti S, Rossi G
Liver Transplant and General Surgery Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Center for Preclincial Research, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Transplant Proc. 2019 Jan-Feb;51(1):111-116. doi: 10.1016/j.transproceed.2018.04.070. Epub 2018 Jun 30.
Machine perfusion is increasingly utilized in liver transplantation to face the detrimental consequences of the use of extended-criteria donors. Hypothermic oxygenated machine perfusion (HOPE) appears to be more protective relative to static cold storage. Conversely, normothermic machine perfusion (NMP) allows a better graft evaluation. We describe a pilot prospective study on machine perfusion in selected grafts.
HOPE was executed for all the grafts procured from donors after cardiac death (DCDs) and for livers from donors after brain death (DBDs) requiring prolonged preservation time. NMP was used when a more precise evaluation was needed. Both HOPE and NMP were performed through the portal vein and hepatic artery.
From July 2016 to November 2017, we performed 7 HOPE procedures: 5 for DCD and 2 for DBD grafts. Two livers presented with macrovesicular steatosis >30% (1 DCD and 1 DBD). HOPE lasted 240 minutes (180-320 min) with a total ischemia time of 575 minutes (410-810 min). Six grafts were successfully transplanted. One DCD graft required additional evaluation using NMP. The graft was then discarded due to extensive hepatocellular necrosis. In the post-transplant course, acute and chronic renal failure were the main complications affecting 3 and 2 recipients, respectively. In our series, steatosis was the main risk factor for kidney injury. Patient and graft survival rate was 100% and no ischemic cholangiopathies were observed after 270 days (106-582 days).
Our study confirms HOPE safety and efficacy for DCD and DBD grafts. These data are particularly significant for DCD management in the Italian setting where the mandatory 20-minute hands-off interval before death declaration further prolongs warm ischemia time.
在肝移植中，为应对使用边缘供体所带来的不良后果，机器灌注的应用日益广泛。相对于静态冷藏，低温氧合机器灌注（HOPE）似乎具有更强的保护作用。相反，常温机器灌注（NMP）能更好地评估移植物。我们描述了一项针对选定移植物进行机器灌注的前瞻性试点研究。
对于所有从心脏死亡供体（DCD）获取的移植物以及需要延长保存时间的脑死亡供体（DBD）肝脏，均采用HOPE。当需要更精确评估时，则使用NMP。HOPE和NMP均通过门静脉和肝动脉进行。
2016年7月至2017年11月，我们进行了7例HOPE操作：5例用于DCD移植物，2例用于DBD移植物。2例肝脏出现大于30%的大泡性脂肪变性（1例DCD和1例DBD）。HOPE持续240分钟（180 - 320分钟），总缺血时间为575分钟（410 - 810分钟）。6例移植物成功移植。1例DCD移植物需要使用NMP进行额外评估。随后，该移植物因广泛的肝细胞坏死而被丢弃。在移植后过程中，急性和慢性肾衰竭是主要并发症，分别影响3例和2例受者。在我们的系列研究中，脂肪变性是肾脏损伤的主要危险因素。患者和移植物存活率均为100%，270天（106 - 582天）后未观察到缺血性胆管病。
我们的研究证实了HOPE对DCD和DBD移植物的安全性和有效性。这些数据对于意大利环境下的DCD管理尤为重要，因为在意大利，死亡宣告前强制的20分钟非接触间隔会进一步延长热缺血时间。
