Sorbonne Université, INSERM Centre de Recherche Saint Antoine UMR S-938, Department of Hepatobiliary Surgery and Liver Transplantation, Hôpital Pitié-Salpêtrière, Assistance Publique- Hopitaux de Paris, France.
Department of Extracorporeal Perfusion and Vascular Surgery, Hôpital Pitié-Salpêtrière, Assistance Publique- Hopitaux de Paris, France.
HPB (Oxford). 2020 Jun;22(6):927-933. doi: 10.1016/j.hpb.2020.04.001. Epub 2020 May 12.
Ex-vivo perfusion of liver grafts is associated with promising results for the preservation of marginal grafts. Recent studies highlight the need for a combination of perfusion conditions, such as hypothermic followed by normothermic perfusion. While comprehensive machines dedicated to liver perfusion have been developed, these systems remain costly and poorly adaptable to perfusion condition switch, which requires a complete interruption of the perfusion process. Our team aimed at developing an adaptable and simple circuit for uninterrupted ex-vivo liver perfusion.
Together with specialized bioengineers, we developed a highly adaptable circuit that can fit on already pre-existing extracorporeal oxygenation machines routinely used in cardiovascular surgery. This circuit, owing to its reservoir, allows any type of perfusion conditions without interrupting the perfusion process.
In a preliminary study, to assess the technical feasibility of liver perfusion using our circuit under different conditions, we performed 7 perfusions of discarded liver grafts. HOPE and DHOPE hypothermic perfusion could be performed, and a switch to normothermia was easily possible within seconds. From there, a dynamic perfusion sequence model was developed.
This circuit may represent a simpler alternative or a new refinement to existing perfusion systems allowing uninterrupted combined perfusion protocols.
肝移植的体外灌注与保存边缘供体具有良好的效果。最近的研究强调了需要组合灌注条件，如低温后常温灌注。虽然已经开发出专门用于肝脏灌注的综合机器，但这些系统仍然昂贵且难以适应灌注条件的切换，这需要完全中断灌注过程。我们的团队旨在开发一种适应性强且简单的不间断体外肝脏灌注回路。
我们与专业的生物工程师一起，开发了一种高度适应性的回路，可以安装在已经存在的体外氧合机上，这些机器通常用于心血管手术。由于其储液器，该回路允许在不中断灌注过程的情况下进行任何类型的灌注条件。
在一项初步研究中，为了评估我们的回路在不同条件下进行肝脏灌注的技术可行性，我们对废弃的肝移植物进行了 7 次灌注。可以进行 HOPE 和 DHOPE 低温灌注，并且可以在几秒钟内轻松切换至常温。由此，开发了一种动态灌注序列模型。
该回路可能是一种更简单的替代方案，或对现有的灌注系统的一种新改进，可以实现不间断的联合灌注方案。
