Department of Surgery, section of Hepatobiliary Surgery & Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.
Clin Transplant. 2022 Aug;36(8):e14762. doi: 10.1111/ctr.14762. Epub 2022 Jul 5.
Cold ischemia time is a well-known risk factor for the development of non-anastomotic biliary strictures (NAS) after liver transplantation. End-ischemic hypothermic oxygenated machine perfusion (HOPE) of DCD liver grafts reduces the incidence of NAS, and has the potential to reduce cold ischemia times. We hypothesized that if a part of the back-table procedure could be performed under continuous HOPE, cold ischemia times would be reduced.
In this prospective observational cohort study, all nationwide declined livers that underwent DHOPE-NMP between July 1st 2021 and January 1st 2022 were included. The back-table of ten consecutive high-risk donor livers was performed with ongoing HOPE. Sixty DHOPE-NMP procedures (August 1st 2017-July 1st 2021) with a conventional back-table procedure functioned as a control group.
Compared to the control group, this technique led to a decrease in non-oxygenated back-table time from median 74 min (IQR 58-92 min) to median 25 min (IQR 21-31 min), p < .01. Median total cold preservation times were reduced from 279 min (IQR 254-297) to 214 min (IQR 132-254), p < .01.
Cold ischemia time of liver grafts can be successfully reduced by over one hour by using portal vein only HOPE during back-table preparation.
冷缺血时间是肝移植后发生非吻合口胆管狭窄（NAS）的已知危险因素。在 DCD 供肝中进行终末期低温氧合机器灌注（HOPE）可降低 NAS 的发生率，并有可能降低冷缺血时间。我们假设，如果一部分台架程序可以在持续 HOPE 下进行，那么冷缺血时间将会缩短。
在这项前瞻性观察队列研究中，纳入了 2021 年 7 月 1 日至 2022 年 1 月 1 日期间进行 DHOPE-NMP 的所有全国范围内被拒绝的供肝。对连续 10 例高危供肝进行了带有持续 HOPE 的台架后处理。60 例 DHOPE-NMP 手术（2017 年 8 月 1 日至 2021 年 7 月 1 日）采用常规台架程序作为对照组。
与对照组相比，该技术可使非氧合台架时间从中位数 74 分钟（IQR 58-92 分钟）缩短至中位数 25 分钟（IQR 21-31 分钟），p<0.01。总冷保存时间中位数从 279 分钟（IQR 254-297）缩短至 214 分钟（IQR 132-254），p<0.01。
通过在台架准备过程中仅使用门静脉进行 HOPE，可以成功地将肝移植物的冷缺血时间缩短一个多小时。
