Werner Maureen J M, van Leeuwen Otto B, de Jong Iris E M, Bodewes Frank A J A, Fujiyoshi Masato, Luhker Olaf C, Scheenstra René, de Vries Yvonne, de Kleine Ruben H J, Porte Robert J
Department of Surgery, Section of Hepato-Pancreato-Biliary Surgery and Liver Transplantation, University Medical Center Groningen, Groningen, The Netherlands.
Department of Pediatric Gastroenterology and Hepatology, University Medical Center Groningen, Groningen, The Netherlands.
Pediatr Transplant. 2019 May;23(3):e13362. doi: 10.1111/petr.13362. Epub 2019 Feb 22.
One of the main limiting factors in pediatric liver transplantation is donor availability. For adults, DCD liver grafts are increasingly used to expand the donor pool. To improve outcome after DCD liver transplantation, ex situ machine perfusion is used as an alternative organ preservation strategy, with the supplemental value of providing oxygen to the graft during preservation. We here report the first successful transplantation of a pediatric DCD liver graft after hypothermic oxygenated machine perfusion. The full-size liver graft was derived from a 13-year-old, female DCD donor and was end-ischemic pretreated with dual hypothermic oxygenated machine perfusion. Arterial and portal pressures were set at 18 and 4 mm Hg, slightly lower than protocolized settings for adult livers. During 2 hours of machine perfusion, portal and arterial flows increased from 100 to 210 mL/min and 30 to 63 mL/min, respectively. The pretreated liver graft was implanted in a 16-year-old girl with progressive familial intrahepatic cholestasis type 2. Postoperative AST, ALT, and prothrombin time normalized within a week. The recipient quickly recovered and was discharged from the hospital after 18 days. One year after transplantation, she is in excellent condition with a completely normal liver function and histology. This case is the first report of successful transplantation of a pediatric DCD liver graft after hypothermic oxygenated machine perfusion and illustrates the potential role of ex situ machine perfusion in expanding the donor pool and improving outcome after pediatric liver transplantation.
小儿肝移植的主要限制因素之一是供体的可获得性。对于成人，越来越多地使用心脏死亡后供体（DCD）肝脏移植物来扩大供体库。为了改善DCD肝移植后的结果，体外机器灌注被用作一种替代的器官保存策略，其附加价值在于在保存期间为移植物提供氧气。我们在此报告首例低温氧合机器灌注后小儿DCD肝脏移植物的成功移植。全尺寸肝脏移植物来自一名13岁的女性DCD供体，并经过双重低温氧合机器灌注进行缺血预处理。动脉压和门静脉压分别设定为18和4 mmHg，略低于成人肝脏的规定设置。在2小时的机器灌注期间，门静脉和动脉血流分别从100 mL/min增加到210 mL/min和从30 mL/min增加到63 mL/min。经过预处理的肝脏移植物被植入一名患有2型进行性家族性肝内胆汁淤积症的16岁女孩体内。术后谷草转氨酶（AST）、谷丙转氨酶（ALT）和凝血酶原时间在一周内恢复正常。受者迅速康复，并在18天后出院。移植一年后，她状况良好，肝功能和组织学完全正常。本病例是首例低温氧合机器灌注后小儿DCD肝脏移植物成功移植的报告，说明了体外机器灌注在扩大小儿肝移植供体库和改善结果方面的潜在作用。
