Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Canadian Donation and Transplant Research Program (CDTRP), University of Alberta, Edmonton, AB, Canada.
Adv Exp Med Biol. 2020;1288:13-31. doi: 10.1007/5584_2020_517.
Recent years have demonstrated a surging interest in normothermic ex situ liver perfusion, with iterative experimental and clinical studies establishing this technology as providing obvious advantages over static cold storage. In particular, the safe prolongation of liver graft preservation even up to 1 week opens up possibilities of 'on circuit' interventions, which may radically change the logistics and scope of liver transplant practice. Such approaches are rife with potential, and have yet to be fully explored. Possibilities may include, but are not limited to mitochondrial enhancing strategies, steatotic graft defatting, on circuit addition of anti-aging compounds, altering graft immunogenic potential and gene silencing with siRNA, stem cell and nanoparticle therapies as well as ischemia free liver preservation. Ex situ machine perfusion technology as a platform for advanced graft modification strategies opens up the possibility of very specific, personalized transplant medicine, as well as the possibility of a future where organ grafts are re-used and repaired, providing utility to numerous successive surgical recipients, indefinitely.
近年来，人们对常温体外肝脏灌注产生了浓厚的兴趣，迭代的实验和临床研究确立了这项技术相对于静态冷藏的明显优势。特别是，安全地延长肝脏供体保存时间甚至达到 1 周，为“回路内”干预提供了可能性，这可能从根本上改变肝脏移植实践的物流和范围。这些方法具有很大的潜力，还有待充分探索。可能性包括但不限于线粒体增强策略、脂肪变性供体去脂、回路内添加抗衰老化合物、改变移植物免疫原性和使用 siRNA 进行基因沉默、干细胞和纳米粒子治疗以及无缺血肝脏保存。作为先进移植物修饰策略平台的体外机器灌注技术为非常具体的、个性化的移植医学开辟了可能性，也为未来器官移植物的再利用和修复提供了可能性，为无数连续的手术受者提供了无限期的使用。
