Guo Zhiyong, Zhao Qiang, Huang Shanzhou, Huang Changjun, Wang Dongping, Yang Lu, Zhang Jian, Chen Maogen, Wu Linwei, Zhang Zhiheng, Zhu Zebin, Wang Linhe, Zhu Caihui, Zhang Yixi, Tang Yunhua, Sun Chengjun, Xiong Wei, Shen Yuekun, Chen Xiaoxiang, Xu Jinghong, Wang Tielong, Ma Yi, Hu Anbin, Chen Yinghua, Zhu Xiaofeng, Rong Jian, Cai Changjie, Gong Fengqiu, Guan Xiangdong, Huang Wenqi, Ko Dicken Shiu-Chung, Li Xianchang, Tullius Stefan G, Huang Jiefu, Ju Weiqiang, He Xiaoshun
Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.
Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China.
Lancet Reg Health West Pac. 2021 Aug 26;16:100260. doi: 10.1016/j.lanwpc.2021.100260. eCollection 2021 Nov.
Background Ischaemia-reperfusion injury is considered an inevitable component of organ transplantation, compromising organ quality and outcomes. Although several treatments have been proposed, none has avoided graft ischaemia and its detrimental consequences. Methods Ischaemia-free liver transplantation (IFLT) comprises surgical techniques enabling continuous oxygenated blood supply to the liver of brain-dead donor during procurement, preservation, and implantation using normothermic machine perfusion technology. In this non-randomised study, 38 donor livers were transplanted using IFLT and compared to 130 conventional liver transplants (CLT). Findings Two recipients (5•3%) in the IFLT group experienced early allograft dysfunction, compared to 50•0% in patients receiving conventional transplants (absolute risk difference, 44•8%; 95% confidence interval, 33•6-55•9%). Recipients of IFLT had significantly reduced median (IQR) peak aspartate aminotransferase levels within the first week compared to CLT recipients (365, 238-697 vs 1445, 791-3244 U/L, p<0•001); likewise, median total bilirubin levels on day 7 were significantly lower (2•34, 1•39-4•09 mg/dL) in the IFLT group than in the CLT group (5•10, 1•90-11•65 mg/dL) (p<0•001). Moreover, IFLT recipients had a shorter median intensive care unit stay (1•48, 0•75-2•00 vs 1•81, 1•00-4•58 days, p=0•006). Both one-month recipient (97•4% vs 90•8%, p=0•302) and graft survival (97.4% vs 90•0%, p=0•195) were better for IFLT than CLT, albeit differences were not statistically significant. Subgroup analysis showed that the extended criteria donor livers transplanted using the IFLT technique yielded faster post-transplant recovery than did the standard criteria donor livers transplanted using the conventional approach. Interpretation IFLT provides a novel approach that may improve outcomes, and allow the successful utilisation of extended criteria livers. Funding This study was funded by National Natural Science Foundation of China, Guangdong Provincial Key Laboratory Construction Projection on Organ Donation and Transplant Immunology, and Guangdong Provincial international Cooperation Base of Science and Technology. Panel: Research in context.
背景 缺血再灌注损伤被认为是器官移植中不可避免的一部分，会影响器官质量和移植结果。尽管已经提出了几种治疗方法，但没有一种能够避免移植物缺血及其有害后果。方法 无缺血肝移植（IFLT）包括一系列手术技术，可在获取、保存和植入过程中，使用常温机器灌注技术，为脑死亡供体的肝脏持续提供含氧血液。在这项非随机研究中，38个供体肝脏采用IFLT进行移植，并与130例传统肝移植（CLT）进行比较。结果 IFLT组中有2名受者（5.3%）发生早期移植物功能障碍，而接受传统移植的患者中这一比例为50.0%（绝对风险差异为44.8%；95%置信区间为33.6 - 55.9%）。与CLT受者相比，IFLT受者在第一周内的天冬氨酸转氨酶峰值中位数（IQR）显著降低（365，238 - 697 vs 1445，791 - 3244 U/L，p<0.001）；同样，IFLT组术后第7天的总胆红素中位数水平（2.34，1.39 - 4.09 mg/dL）显著低于CLT组（5.10，1.90 - 11.65 mg/dL）（p<0.001）。此外，IFLT受者在重症监护病房的住院时间中位数更短（1.48，0.75 - 2.00 vs 1.81，1.00 - 4.58天，p = 0.006）。IFLT组的受者1个月生存率（97.4% vs 90.8%，p = 0.302）和移植物生存率（97.4% vs 90.0%，p = 0.195）均高于CLT组，尽管差异无统计学意义。亚组分析表明，采用IFLT技术移植的扩展标准供体肝脏比采用传统方法移植标准标准供体肝脏的术后恢复更快。解读 IFLT提供了一种可能改善移植结果的新方法，并能成功利用扩展标准肝脏。资助 本研究由中国国家自然科学基金、广东省器官捐献与移植免疫重点实验室建设项目以及广东省国际科技合作基地资助。专家组：研究背景。
