Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida, USA.
Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA.
Liver Transpl. 2023 Dec 1;29(12):1282-1291. doi: 10.1097/LVT.0000000000000156. Epub 2023 Apr 13.
In situ abdominal normothermic regional perfusion (A-NRP) has been used for liver transplantation (LT) with donation after circulatory death (DCD) liver grafts in Europe with excellent results; however, adoption of A-NRP in the United States has been lacking. The current report describes the implementation and results of a portable, self-reliant A-NRP program in the United States. Isolated abdominal in situ perfusion with an extracorporeal circuit was achieved through cannulation in the abdomen or femoral vessels and inflation of a supraceliac aortic balloon and cross-clamp. The Quantum Transport System by Spectrum was used. The decision to use livers for LT was made through an assessment of perfusate lactate (q15min). From May to November 2022, 14 A-NRP donation after circulatory death procurements were performed by our abdominal transplant team (N = 11 LT, N = 20 kidney transplants, and 1 kidney-pancreas transplant). The median A-NRP run time was 68 minutes. None of the LT recipients had post-reperfusion syndrome, nor were there any cases of primary nonfunction. All livers were functioning well at the time of maximal follow-up with zero cases of ischemic cholangiopathy. The current report describes the feasibility of a portable A-NRP program that can be used in the United States. Excellent short-term post-transplant results were achieved with both livers and kidneys procured from A-NRP.
原位腹部常温区域灌注(A-NRP)已在欧洲用于循环死亡后供肝的肝移植(LT),取得了极好的效果;然而,A-NRP 在美国的应用却一直不足。本报告描述了一种在美国使用的便携式、自给自足的 A-NRP 方案的实施情况和结果。通过腹部或股血管的插管以及腹主动脉球囊和交叉夹的充气,实现了离体腹部原位灌注与体外循环。使用的是 Spectrum 的 Quantum Transport System。是否使用肝脏进行 LT 的决定是通过评估灌注液中的乳酸(q15min)来做出的。2022 年 5 月至 11 月,我们的腹部移植团队进行了 14 例 A-NRP 循环死亡供肝采集(N=11 例 LT,N=20 例肾移植,1 例肾胰联合移植)。A-NRP 的中位运行时间为 68 分钟。LT 受者无一例发生再灌注综合征,也无一例发生原发性无功能。在随访的最大时间点,所有肝脏的功能均良好,无一例发生缺血性胆管炎。本报告描述了一种在美国使用的便携式 A-NRP 方案的可行性。通过 A-NRP 采集的肝脏和肾脏均取得了极好的短期移植后效果。