General Surgery 2U - Liver Transplant Unit. Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino - University of Turin, Turin.
Center for Preclinical Research, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy.
Curr Opin Organ Transplant. 2022 Oct 1;27(5):454-465. doi: 10.1097/MOT.0000000000001004. Epub 2022 Jul 15.
Viability assessment is one of the main indications for machine perfusion (MP) in liver transplantation. This review summarizes the rationale, evolution and limitations of proposed viability criteria and suggests a framework for future studies.
Liver viability is most frequently assessed during normothermic MP by combining parameters relative to perfusate and bile composition, vascular flows and macroscopic aspect. Assessment protocols are largely heterogeneous and have significantly evolved over time, also within the same group, reflecting the ongoing evolution of the subject. Several recent preclinical studies using discarded human livers or animal models have explored other approaches to viability assessment. During hypothermic MP, perfusate flavin mononucleotide has emerged as a promising biomarker of mitochondrial injury and function. Most studies on the subject suffer from limitations, including low numbers, lack of multicenter validation, and subjective interpretation of some viability parameters.
MP adds a further element of complexity in the process of assessing the quality of a liver graft. Understanding the physiology of the parameters included in the different assessment protocols is necessary for their correct interpretation. Despite the possibility of assessing liver viability during MP, the importance of donor-recipient matching and operational variables should not be disregarded.
在肝移植中，机器灌注（MP）的主要适应证之一是评估供肝的活力。本综述总结了目前提出的活力评估标准的原理、演变和局限性，并为未来的研究提出了一个框架。
在常温 MP 期间，通过结合与灌流液和胆汁成分、血流和宏观外观相关的参数，最常评估肝的活力。评估方案在很大程度上存在异质性，并且随着时间的推移发生了显著变化，即使在同一组内也是如此，这反映了该主题的不断发展。最近的一些使用废弃的人类肝脏或动物模型的临床前研究探索了其他评估活力的方法。在低温 MP 期间，灌流液黄素单核苷酸已成为评估线粒体损伤和功能的有前途的生物标志物。该主题的大多数研究都存在局限性，包括数量少、缺乏多中心验证以及对一些活力参数的主观解释。
MP 在评估供肝质量的过程中增加了另一个复杂性因素。为了正确解释不同评估方案中包含的参数，了解这些参数的生理学原理是必要的。尽管在 MP 期间可以评估肝的活力，但不应忽视供体-受者匹配和操作变量的重要性。
