Saemann Lars, Guo Yuxing, Ding Qingwei, Zhou Pengyu, Karck Matthias, Szabó Gábor, Wenzel Folker
Department of Cardiac Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 326, Heidelberg 69120, Germany; Faculty Medical and Life Sciences, Furtwangen University, Jakob-Kienzle-Straße 17, Villingen-Schwenningen 78054, Germany.
Department of Cardiac Surgery, University Hospital Heidelberg, Im Neuenheimer Feld 326, Heidelberg 69120, Germany.
Transplant Rev (Orlando). 2020 Jul;34(3):100551. doi: 10.1016/j.trre.2020.100551. Epub 2020 May 12.
Ex vivo machine perfusion (EVMP) is reported to can successfully be applied for donor heart preservation. To respond to the organ shortage, some centres also accept hearts from marginal donors such as non-heart beating donors (NHBD) or hearts donated after cardiac death (DCD) for heart transplantation (HTx). Clinical as well as preclinical science on EVMP of DCD hearts seems to be promising but the ideal perfusion practice itself appears unclear.
In accordance with the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews (PRISMA), this systematic review scopes all EVMP techniques for human and animal DCD heart preservation and addresses three specific questions, which refer to (a) the perfusion solutions, (b) the perfusion parameters and respective target values and (c) if possible, a direct comparison between cold static storage (CSS) and EVMP.
Search results predominantly consisted of animal studies. Either perfusion with a crystalloid or blood-based solution, each with cardioplegic or non-cardioplegic properties was used. Some perfusates were supplemented with specific pharmacological medication to block pathophysiological pathways, which are involved in ischemia/reperfusion injury or edema formation. Besides normothermic EVMP with oxygenated blood, a wide range of temperature was applied in all approaches, with the lowest temperature at 4 °C. Pressure controlled anterograde Langendorff perfusion was applied mostly. If investigated, crystalloid machine perfusion was presented superior to CSS.
Only blood based EVMP was introduced into clinical practice. More research, clinical as well as preclinical, is needed to develop the ideal EVMP technique, in terms of blood or crystalloid perfusion.
据报道，体外机器灌注（EVMP）可成功应用于供体心脏保存。为应对器官短缺问题，一些中心也接受来自边缘供体的心脏，如非心脏跳动供体（NHBD）或心脏死亡后捐赠的心脏（DCD）用于心脏移植（HTx）。关于DCD心脏的EVMP的临床及临床前研究似乎很有前景，但理想的灌注方法本身似乎并不明确。
根据系统评价和Meta分析扩展版的范围综述的首选报告项目（PRISMA），本系统综述涵盖了用于人类和动物DCD心脏保存的所有EVMP技术，并解决了三个具体问题，即（a）灌注液，（b）灌注参数及各自的目标值，以及（c）如果可能，冷静态保存（CSS）和EVMP之间的直接比较。
检索结果主要包括动物研究。使用了晶体液或血液基溶液进行灌注，每种溶液都具有心脏停搏或非心脏停搏特性。一些灌注液添加了特定的药物以阻断参与缺血/再灌注损伤或水肿形成的病理生理途径。除了用含氧血进行常温EVMP外，所有方法都应用了广泛的温度范围，最低温度为4℃。大多采用压力控制的顺行Langendorff灌注。如果进行了研究，晶体液机器灌注表现优于CSS。
只有基于血液的EVMP被引入临床实践。在血液或晶体液灌注方面，需要更多的临床及临床前研究来开发理想的EVMP技术。
