Lab of Abdominal Transplantation, Transplantation Research Group, Department of Microbiology, Immunology and Transplantation, KU Leuven, Leuven, Belgium.
Department of Abdominal Transplantation, University Hospitals Leuven, Leuven, Belgium.
Transpl Int. 2022 Mar 14;35:10312. doi: 10.3389/ti.2022.10312. eCollection 2022.
Predicting organ viability before transplantation remains one of the most challenging and ambitious objectives in transplant surgery. Waitlist mortality is high while transplantable organs are discarded. Currently, around 20% of deceased donor kidneys and livers are discarded because of "poor organ quality", Decisions to discard are still mainly a subjective judgement since there are only limited reliable tools predictive of outcome available. Organ perfusion technology has been posed as a platform for pre-transplant organ viability assessment. Markers of graft injury and function as well as perfusion parameters have been investigated as possible viability markers during hypothermic and normothermic perfusion. We provide an overview of the available evidence for the use of kidney and liver perfusion as a tool to predict posttransplant outcomes. Although evidence shows post-transplant outcomes can be predicted by both injury markers and perfusion parameters during hypothermic kidney perfusion, the predictive accuracy is too low to warrant clinical decision making based upon these parameters alone. In liver, further evidence on the usefulness of hypothermic perfusion as a predictive tool is needed. Normothermic perfusion, during which the organ remains fully metabolically active, seems a more promising platform for true viability assessment. Although we do not yet fully understand "on-pump" organ behaviour at normothermia, initial data in kidney and liver are promising. Besides the need for well-designed (registry) studies to advance the field, the catch-22 of selection bias in clinical studies needs addressing.
在移植前预测器官的存活能力仍然是移植手术中最具挑战性和雄心勃勃的目标之一。由于“器官质量差”，候补名单上的死亡率很高，可移植的器官却被丢弃。目前，大约 20%的已故捐赠者的肾脏和肝脏由于“器官质量差”而被丢弃。由于目前只有有限的可靠工具可以预测结果，因此做出丢弃的决定仍然主要是主观判断。器官灌注技术已被提出作为移植前器官存活能力评估的平台。在低温和常温灌注过程中，已经研究了损伤和功能标志物以及灌注参数作为可能的存活标志物。我们提供了有关肾脏和肝脏灌注作为预测移植后结果的工具的现有证据概述。尽管证据表明，在低温肾脏灌注过程中，损伤标志物和灌注参数都可以预测移植后的结果，但预测的准确性太低，不能仅基于这些参数做出临床决策。在肝脏中，需要进一步的证据来证明低温灌注作为预测工具的有用性。在常温下，器官保持完全代谢活跃的常温灌注似乎是一种更有前途的真正存活能力评估平台。虽然我们还不完全了解常温下“泵内”器官的行为，但肾脏和肝脏的初步数据很有希望。除了需要进行精心设计的（注册）研究来推动该领域的发展外，还需要解决临床研究中选择偏差的两难困境。
