Huang Changjun, Chen Zhitao, Wang Tielong, He Xiaoshun, Chen Maogen, Ju Weiqiang
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, China.
Ann Transl Med. 2021 Mar;9(5):425. doi: 10.21037/atm-20-6296.
The shortage of transplant organs remains a serious issue worldwide, and using liver grafts from extended criteria donors could expand the donor pool. Extended criteria donor liver allografts have a high chance of complications such as primary nonfunction, early allograft dysfunction, and ischemic-type biliary lesions. How to employ these extended criteria donors safely and effectively warrants further investigation. Herein, we report the successful use of a marginal donor liver with hyperbilirubinemia to save the life of an acute-on-chronic liver failure recipient using a new surgical technique: ischemia-free liver transplantation (IFLT). The graft was retrieved for transplantation due to the following reasons: (I) the recipient was in a life-threatening situation and no living donor donation candidate was available; (II) the graft was considered transplantable except for cholestasis; and (III) IFLT could reduce ischemia/reperfusion injury (IRI), resuscitate the allograft , and maintain organ viability before transplantation. The graft was transplanted successfully using the IFLT procedure. Although anatomic biliary stricture occurred after surgery, no IRI-related complications were found during the follow-up. The use of liver grafts from extended criteria donors is safe and effective under IFLT. Additional IFLT clinical studies need to be performed, particularly concerning donor management, graft selection, and resuscitation.
移植器官短缺在全球范围内仍是一个严重问题，使用扩大标准供体的肝脏移植物可扩大供体库。扩大标准供体肝脏同种异体移植物发生原发性无功能、早期移植物功能障碍和缺血型胆管病变等并发症的几率很高。如何安全有效地利用这些扩大标准供体值得进一步研究。在此，我们报告了使用一种新的手术技术——无缺血肝移植（IFLT），成功利用一例合并高胆红素血症的边缘供体肝脏挽救了一名慢性肝功能衰竭急性发作受体的生命。该移植物因以下原因被获取用于移植：（I）受体处于危及生命的状况且没有活体供体捐献候选者；（II）除胆汁淤积外，该移植物被认为可用于移植；（III）IFLT可减少缺血/再灌注损伤（IRI），使同种异体移植物复苏，并在移植前维持器官活力。使用IFLT手术成功移植了该移植物。尽管术后发生了解剖性胆管狭窄，但随访期间未发现与IRI相关的并发症。在IFLT下，使用扩大标准供体的肝脏移植物是安全有效的。需要开展更多IFLT临床研究，尤其是关于供体管理、移植物选择和复苏方面的研究。
