重复肝移植中肝移植器官常温机器灌注的结果（那不勒斯倡议）。
Outcomes of normothermic machine perfusion of liver grafts in repeat liver transplantation (NAPLES initiative).
作者信息
Hann A, Lembach H, Nutu A, Dassanayake B, Tillakaratne S, McKay S C, Boteon A P C S, Boteon Y L, Mergental H, Murphy N, Bangash M N, Neil D A H, Issac J L, Javed N, Faulkner T, Bennet D, Moore R, Vasanth S, Subash G, Cuell J, Rao R, Cilliers H, Russel S, Haydon G, Mutimer D, Roberts K J, Mirza D F, Ferguson J, Bartlett D, Isaac J R, Rajoriya N, Armstrong M J, Hartog H, Perera M T P R
机构信息
Liver Unit, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, UK.
出版信息
Br J Surg. 2022 Mar 15;109(4):372-380. doi: 10.1093/bjs/znab475.
BACKGROUND
Retransplantation candidates are disadvantaged owing to lack of good-quality liver grafts. Strategies that can facilitate transplantation of suboptimal grafts into retransplant candidates require investigation. The aim was to determine whether late liver retransplantation can be performed safely with suboptimal grafts, following normothermic machine perfusion.
METHODS
A prospectively enrolled group of patients who required liver retransplantation received a suboptimal graft preserved via normothermic machine perfusion. This group was compared with both historical and contemporaneous cohorts of patient who received grafts preserved by cold storage. The primary outcome was 6-month graft and patient survival.
RESULTS
The normothermic machine perfusion group comprised 26 patients. The historical (cold storage 1) and contemporaneous (cold storage 2) groups comprised 31 and 25 patients respectively. The 6-month graft survival rate did not differ between groups (cold storage 1, 27 of 31, cold storage 2, 22 of 25; normothermic machine perfusion, 22 of 26; P = 0.934). This was despite the normothermic machine perfusion group having significantly more steatotic grafts (8 of 31, 7 of 25, and 14 of 26 respectively; P = 0.006) and grafts previously declined by at least one other transplant centre (5 of 31, 9 of 25, and 21 of 26; P < 0.001).
CONCLUSION
In liver retransplantation, normothermic machine perfusion can safely expand graft options without compromising short-term outcomes.
背景
再次移植的候选者因缺乏高质量肝脏移植物而处于不利地位。能够促进将次优移植物移植到再次移植候选者体内的策略需要进行研究。目的是确定在常温机器灌注后，使用次优移植物进行晚期肝脏再次移植是否能够安全进行。
方法
一组前瞻性纳入的需要肝脏再次移植的患者接受了通过常温机器灌注保存的次优移植物。将该组与接受冷藏保存移植物的历史队列和同期队列患者进行比较。主要结局是6个月时的移植物和患者生存率。
结果
常温机器灌注组包括26例患者。历史组（冷藏1组）和同期组（冷藏2组）分别包括31例和25例患者。各组之间的6个月移植物生存率没有差异（冷藏1组，31例中的27例；冷藏2组，25例中的22例；常温机器灌注组，26例中的22例；P = 0.934）。尽管常温机器灌注组有明显更多的脂肪变性移植物（分别为31例中的8例、25例中的7例和26例中的14例；P = 0.006）以及此前被至少一个其他移植中心拒绝的移植物（31例中的5例、25例中的9例和26例中的21例；P < 0.001）。
结论
在肝脏再次移植中，常温机器灌注可以安全地扩大移植物选择范围，而不会影响短期结局。
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