Department of Surgery, University of Alberta, Edmonton, AB, Canada.
Transplantation. 2020 Sep;104(9):1804-1812. doi: 10.1097/TP.0000000000003320.
Machine perfusion (MP) is at the forefront of innovation in modern liver transplantation. Several approaches, mainly varying the temperature at which the graft is perfused, have shown benefit in preclinical models and nonrandomized clinical trials. Given the recent randomized controlled trial by Nasralla et al demonstrating the efficacy of normothermic MP over static cold storage, MP is likely here to stay for the foreseeable future. We are only beginning to explore the possibilities of this technology, including the prediction of graft function and modification of suboptimal livers. This has the potential to both increase the donor pool and improve the quality of grafts provided to recipients. Beyond transplantation, there may be a role for MP in extracorporeal liver support, cancer research and therapeutics, and pharmaceutical testing. In this review, we provide the rationale and explore the relevant preclinical studies that support the use of ex situ liver perfusion for these extended applications.
机器灌注 (MP) 是现代肝移植创新的前沿。几种方法，主要是改变供体灌注的温度，在临床前模型和非随机临床试验中显示出益处。鉴于最近 Nasralla 等人进行的随机对照试验证明了常温 MP 优于静态低温保存的效果，MP 很可能在可预见的未来得到应用。我们才刚刚开始探索这项技术的可能性，包括预测移植物功能和修饰不理想的肝脏。这有可能增加供体库并提高提供给受者的移植物质量。除了移植，MP 在体外肝脏支持、癌症研究和治疗以及药物测试中可能也有作用。在这篇综述中，我们提供了使用离体肝脏灌注进行这些扩展应用的基本原理，并探讨了支持这一应用的相关临床前研究。
