Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
J Hepatol. 2022 Sep;77(3):825-836. doi: 10.1016/j.jhep.2022.04.033. Epub 2022 May 6.
Liver transplantation has become an immense success; nevertheless, far more recipients are registered on waiting lists than there are available donor livers for transplantation. High-risk, extended criteria donor livers are increasingly used to reduce the discrepancy between organ demand and supply. Especially for high-risk livers, dynamic preservation using machine perfusion can decrease post-transplantation complications and may increase donor liver utilisation by improving graft quality and enabling viability testing before transplantation. To further increase the availability of donor livers suitable for transplantation, new strategies are required that make it possible to use organs that are initially too damaged to be transplanted. With the current progress in experimental liver transplantation research, (long-term) normothermic machine perfusion may be used in the future as a dynamic platform for regenerative medicine approaches, enabling repair and regeneration of injured donor livers. Currently explored therapeutics such as defatting cocktails, RNA interference, senolytics, and stem cell therapy may assist in the repair and/or regeneration of injured livers before transplantation. This review will provide a forecast of the future utility of normothermic machine perfusion in decreasing the imbalance between donor liver demand and supply by enabling the repair and regeneration of damaged donor livers.
肝移植已经取得了巨大的成功；然而，等待移植的患者远远多于可供移植的供体肝脏。为了减少器官需求与供应之间的差距，越来越多的高危、扩展标准供体肝脏被用于移植。特别是对于高危肝脏，使用机器灌注进行动态保存可以减少移植后的并发症，并通过改善移植物质量和在移植前进行活力测试来增加供体肝脏的利用率。为了进一步增加适合移植的供体肝脏的可用性，需要采用新的策略，使最初因损伤过大而无法移植的器官能够使用。随着实验性肝移植研究的当前进展，（长期）常温机器灌注可能在未来被用作再生医学方法的动态平台，从而实现受损供体肝脏的修复和再生。目前正在探索的治疗方法，如脱脂鸡尾酒、RNA 干扰、衰老细胞清除剂和干细胞治疗，可能有助于在移植前修复和/或再生受损的肝脏。这篇综述将预测常温机器灌注在减少供体肝脏需求与供应之间的不平衡方面的未来应用，通过修复和再生受损的供体肝脏来实现这一目标。
