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美国便携式腹部常温区域灌注(A-NRP)项目的开发。

Development of a portable abdominal normothermic regional perfusion (A-NRP) program in the United States.

机构信息

Department of Transplant, Mayo Clinic Florida, Jacksonville, Florida, USA.

Division of Cardiothoracic Surgery, Department of Surgery, Mayo Clinic Florida, Jacksonville, Florida, USA.

出版信息

Liver Transpl. 2023 Dec 1;29(12):1282-1291. doi: 10.1097/LVT.0000000000000156. Epub 2023 Apr 13.

Abstract

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.

摘要

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。

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