Department of Surgery, Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus MC Transplant Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Am J Transplant. 2022 Dec;22(12):2723-2739. doi: 10.1111/ajt.17161. Epub 2022 Aug 25.
The use of extended criteria donor grafts is a promising strategy to increase the number of organ transplantations and reduce waitlist mortality. However, these organs are often compromised and/or damaged, are more susceptible to preservation injury, and are at risk for developing post-transplant complications. Ex vivo organ perfusion is a novel technology to preserve donor organs while providing oxygen and nutrients at distinct perfusion temperatures. This preservation method allows to resuscitate grafts and optimize function with therapeutic interventions prior to solid organ transplantation. Stem cell-based therapies are increasingly explored for their ability to promote regeneration and reduce the inflammatory response associated with in vivo reperfusion. The aim of this review is to describe the current state of stem cell-based therapies during ex vivo organ perfusion for the kidney, liver, lung, and heart. We discuss different strategies, including type of cells, route of administration, mechanisms of action, efficacy, and safety. The progress made within lung transplantation justifies the initiation of clinical trials, whereas more research is likely required for the kidney, liver, and heart to progress into clinical application. We emphasize the need for standardization of methodology to increase comparability between future (clinical) studies.
使用扩展标准供体移植物是增加器官移植数量和降低等待名单死亡率的一种有前途的策略。然而，这些器官通常受损或受损，更容易受到保存损伤的影响，并存在发生移植后并发症的风险。离体器官灌注是一种新的技术，可以在提供氧气和营养物质的同时，以不同的灌注温度保存供体器官。这种保存方法允许在实体器官移植前复苏移植物并通过治疗干预优化功能。基于干细胞的疗法因其促进再生和减少与体内再灌注相关的炎症反应的能力而越来越受到关注。本综述的目的是描述目前在肾脏、肝脏、肺和心脏的离体器官灌注中基于干细胞的治疗方法的现状。我们讨论了不同的策略，包括细胞类型、给药途径、作用机制、疗效和安全性。在肺移植方面取得的进展证明了启动临床试验的合理性，而在肾脏、肝脏和心脏方面，可能需要更多的研究才能将其推进到临床应用。我们强调需要标准化方法，以增加未来（临床）研究之间的可比性。
