Department of Anesthesia and Critical Care, Azienda Ospedaliero Universitaria Città della Salute e della Scienza di Torino, Turin, Italy.
Department of Surgical Sciences, University of Turin, Turin, Italy.
Artif Organs. 2023 Oct;47(10):1592-1603. doi: 10.1111/aor.14622. Epub 2023 Aug 7.
Abdominal normothermic regional perfusion (A-NRP) allows in-situ reperfusion and recovery of abdominal organs metabolism in donors after circulatory death (DCD). Besides improving liver transplantation outcomes, liver injury and function can be assessed during A-NRP.
To refine liver viability assessment during A-NRP, prospectively collected data of controlled DCD donors managed at our Institution between October 2019 and May 2022 were retrospectively analyzed. Baseline characteristics, procedural variables and A-NRP parameters of donors whose liver was successfully transplanted were compared to those of donors whose liver was discarded.
Twenty-seven donors were included and in 20 (74%) the liver was accepted (positive outcome). No differences between study groups were observed concerning baseline characteristics and warm ischemia times (WIT). Initial lactate levels were positively correlated with functional WIT (r = 0.4, p = 0.04), whereas transaminase levels were not. Blood flow during A-NRP was comparable, whereas oxygen consumption (VO ) was significantly higher in the positive outcome group after 1 h. Time courses of lactate, AST and ALT were significantly different between study groups (p < 0.001). Donors whose liver was accepted showed faster lactate clearance, a difference which was amplified by normalizing lactate clearance to oxygen delivery (DO ) and VO . Lactate clearance was correlated to transaminase levels and DO -normalized lactate clearance was the parameter best discriminating between study groups.
DO -normalized lactate clearance may represent an element of liver viability assessment during A-NRP.
腹部常温区域性灌注（A-NRP）允许在循环死亡（DCD）供体中进行原位再灌注和恢复腹部器官代谢。除了改善肝移植结果外，还可以在 A-NRP 期间评估肝损伤和功能。
为了在 A-NRP 期间细化肝活力评估，回顾性分析了 2019 年 10 月至 2022 年 5 月期间在我们机构管理的受控 DCD 供体的前瞻性收集数据。将成功移植肝脏的供体的基线特征、程序变量和 A-NRP 参数与那些肝脏被丢弃的供体进行比较。
共纳入 27 名供体，其中 20 名（74%）的肝脏被接受（阳性结果）。研究组之间在基线特征和热缺血时间（WIT）方面无差异。初始乳酸水平与功能性 WIT 呈正相关（r=0.4，p=0.04），而转氨酶水平则没有。A-NRP 期间的血流相似，而在 1 小时后，阳性结果组的氧消耗（VO ）显著更高。乳酸、AST 和 ALT 的时间过程在研究组之间有显著差异（p<0.001）。接受肝脏的供体乳酸清除更快，通过将乳酸清除率归一化为氧输送（DO ）和 VO ，这种差异得到放大。乳酸清除率与转氨酶水平相关，而 DO 归一化的乳酸清除率是区分研究组的最佳参数。
DO 归一化的乳酸清除率可能是 A-NRP 期间肝活力评估的一个要素。
