Division of Cardiac Surgery, Thomas Jefferson University, Philadelphia, PA, USA.
Artif Organs. 2021 Jul;45(7):682-695. doi: 10.1111/aor.13894. Epub 2021 Mar 9.
The ever-widening gap between organ supply and demand has resulted in an organ shortage crisis that affects patients all over the world. For decades, static cold storage (SCS) was the gold standard preservation strategy because of its simplicity and cost-effectiveness, but the rising unmet demand for donor organ transplants has prompted investigation into preservation strategies that can expand the available donor pool. Through ex vivo functional assessment of the organ prior to transplant, newer methods to preserve organs such as perfusion-based therapy can potentially expand the available organ pool. This review will explain the physiologic rationale for SCS before exploring the advantages and disadvantages associated with the two broad classes of preservation strategies that have emerged to address the crisis: hypothermic and normothermic machine perfusion. A detailed analysis of how each preservation strategy works will be provided before investigating the current status of clinical data for each preservation strategy for the kidney, liver, pancreas, heart, and lung. For some organs there is robust data to support the use of machine perfusion technologies over SCS, and in others the data are less clear. Nonetheless, machine perfusion technologies represent an exciting frontier in organ preservation research and will remain a crucial component of closing the gap between organ supply and recipient demand.
供体器官的供应与需求之间不断扩大的差距导致了器官短缺危机，影响了全球各地的患者。几十年来，由于其简单性和成本效益，静态低温保存（SCS）一直是金标准的保存策略，但对供体器官移植的需求不断增加，促使人们研究能够扩大可供器官来源的保存策略。通过在移植前对器官进行体外功能评估，新的保存方法，如基于灌注的治疗，可以潜在地扩大可供器官的来源。本综述将在探讨解决这一危机的两种广泛的保存策略的优缺点之前，解释 SCS 的生理原理：低温和常温机器灌注。在研究每种保存策略的临床数据现状之前，将详细分析每种保存策略的工作原理，包括肾脏、肝脏、胰腺、心脏和肺。对于某些器官，有强有力的数据支持使用机器灌注技术而不是 SCS，而对于其他器官，数据则不太清楚。尽管如此，机器灌注技术代表了器官保存研究的一个令人兴奋的前沿领域，并且仍然是缩小供体器官供应与受者需求差距的关键组成部分。
