Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, 510080, China; NHC Key Laboratory of Assisted Circulation, Sun Yat-sen University, China.
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou, 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou, 510080, China.
J Hepatol. 2023 Aug;79(2):394-402. doi: 10.1016/j.jhep.2023.04.010. Epub 2023 Apr 20.
BACKGROUND & AIMS: Ischemia-reperfusion injury (IRI) has thus far been considered as an inevitable component of organ transplantation, compromising outcomes, and limiting organ availability. Ischemia-free organ transplantation is a novel approach designed to avoid IRI, with the potential to improve outcomes.
In this randomized-controlled clinical trial, recipients of livers from donors after brain death were randomly assigned to receive either an ischemia-free or a 'conventional' transplant. The primary endpoint was the incidence of early allograft dysfunction. Secondary endpoints included complications related to graft IRI.
Out of 68 randomized patients, 65 underwent transplants and were included in the analysis. 32 patients received ischemia-free liver transplantation (IFLT), and 33 received conventional liver transplantation (CLT). Early allograft dysfunction occurred in two recipients (6%) randomized to IFLT and in eight (24%) randomized to CLT (difference -18%; 95% CI -35% to -1%; p = 0.044). Post-reperfusion syndrome occurred in three recipients (9%) randomized to IFLT and in 21 (64%) randomized to CLT (difference -54%; 95% CI -74% to -35%; p <0.001). Non-anastomotic biliary strictures diagnosed with protocol magnetic resonance cholangiopancreatography at 12 months were observed in two recipients (8%) randomized to IFLT and in nine (36%) randomized to CLT (difference, -28%; 95% CI -50% to -7%; p = 0.014). The comprehensive complication index at 1 year after transplantation was 30.48 (95% CI 23.25-37.71) in the IFLT group vs. 42.14 (95% CI 35.01-49.26) in the CLT group (difference -11.66; 95% CI -21.81 to -1.51; p = 0.025).
Among patients with end-stage liver disease, IFLT significantly reduced complications related to IRI compared to a conventional approach.
chictr.org. ChiCTR1900021158.
Ischemia-reperfusion injury has thus far been considered as an inevitable event in organ transplantation, compromising outcomes and limiting organ availability. Ischemia-free liver transplantation is a novel approach of transplanting donor livers without interruption of blood supply. We showed that in patients with end-stage liver disease, ischemia-free liver transplantation, compared with a conventional approach, led to reduced complications related to ischemia-reperfusion injury in this randomized trial. This new approach is expected to change the current practice in organ transplantation, improving transplant outcomes, increasing organ utilization, while providing a clinical model to delineate the impact of organ injury on alloimmunity.
缺血再灌注损伤（IRI）一直被认为是器官移植中不可避免的组成部分，会影响移植效果，并限制器官的可用性。无缺血器官移植是一种旨在避免 IRI 的新方法，有潜力改善移植效果。
在这项随机对照临床试验中，脑死亡供体的肝脏受体被随机分配接受无缺血或“常规”移植。主要终点是早期移植物功能障碍的发生率。次要终点包括与移植物 IRI 相关的并发症。
在 68 名随机患者中，有 65 名接受了移植并纳入了分析。32 名患者接受了无缺血肝移植（IFLT），33 名患者接受了常规肝移植（CLT）。2 名（6%）随机接受 IFLT 的患者和 8 名（24%）随机接受 CLT 的患者发生早期移植物功能障碍（差异-18%；95%CI-35%至-1%；p=0.044）。3 名（9%）随机接受 IFLT 的患者和 21 名（64%）随机接受 CLT 的患者发生再灌注后综合征（差异-54%；95%CI-74%至-35%；p<0.001）。在 12 个月时，通过协议磁共振胰胆管造影术诊断的非吻合口胆狭窄在 2 名（8%）随机接受 IFLT 的患者和 9 名（36%）随机接受 CLT 的患者中观察到（差异，-28%；95%CI-50%至-7%；p=0.014）。移植后 1 年的综合并发症指数在 IFLT 组为 30.48（95%CI 23.25-37.71），在 CLT 组为 42.14（95%CI 35.01-49.26）（差异-11.66；95%CI-21.81 至-1.51；p=0.025）。
在终末期肝病患者中，与常规方法相比，IFLT 显著降低了与 IRI 相关的并发症。
chictr.org. ChiCTR1900021158.
缺血再灌注损伤一直被认为是器官移植中不可避免的事件，会影响移植效果，并限制器官的可用性。无缺血肝移植是一种在不中断血液供应的情况下移植供体肝脏的新方法。我们在这项随机试验中表明，在终末期肝病患者中，与常规方法相比，无缺血肝移植可降低与缺血再灌注损伤相关的并发症。这种新方法有望改变目前的器官移植实践，改善移植效果，增加器官利用率，同时为阐明器官损伤对同种免疫的影响提供临床模型。
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