Widmer Jeannette, Eden Janina, Carvalho Mauricio Flores, Dutkowski Philipp, Schlegel Andrea
Department of Surgery and Transplantation, Swiss HPB Centre, University Hospital Zurich, 8091 Zürich, Switzerland.
Hepatobiliary Unit, Department of Clinical and Experimental Medicine, University of Florence, AOU Careggi, 50139 Florence, Italy.
J Clin Med. 2022 Sep 3;11(17):5218. doi: 10.3390/jcm11175218.
Based on the renaissance of dynamic preservation techniques, extended criteria donor (ECD) livers reclaimed a valuable eligibility in the transplantable organ pool. Being more vulnerable to ischemia, ECD livers carry an increased risk of early allograft dysfunction, primary non-function and biliary complications and, hence, unveiled the limitations of static cold storage (SCS). There is growing evidence that dynamic preservation techniques-dissimilar to SCS-mitigate reperfusion injury by reconditioning organs prior transplantation and therefore represent a useful platform to assess viability. Yet, a debate is ongoing about the advantages and disadvantages of different perfusion strategies and their best possible applications for specific categories of marginal livers, including organs from donors after circulatory death (DCD) and brain death (DBD) with extended criteria, split livers and steatotic grafts. This review critically discusses the current clinical spectrum of livers from ECD donors together with the various challenges and posttransplant outcomes in the context of standard cold storage preservation. Based on this, the potential role of machine perfusion techniques is highlighted next. Finally, future perspectives focusing on how to achieve higher utilization rates of the available donor pool are highlighted.
基于动态保存技术的复兴，边缘供体（ECD）肝脏在可移植器官库中重新获得了宝贵的合格地位。ECD肝脏对缺血更敏感，早期移植肝功能障碍、原发性无功能和胆道并发症的风险增加，因此揭示了静态冷保存（SCS）的局限性。越来越多的证据表明，与SCS不同，动态保存技术通过在移植前对器官进行预处理来减轻再灌注损伤，因此是评估肝脏活力的有用平台。然而，关于不同灌注策略的优缺点及其对特定类型边缘肝脏（包括来自循环死亡（DCD）和脑死亡（DBD）且符合扩展标准的供体器官、劈离式肝脏和脂肪变性移植物）的最佳应用，仍在进行辩论。本综述批判性地讨论了ECD供体肝脏的当前临床情况，以及在标准冷保存背景下的各种挑战和移植后结果。基于此，接下来强调了机器灌注技术的潜在作用。最后，重点突出了关于如何提高可用供体库利用率的未来展望。
