Oxford Transplant Centre, Nuffield Department of Surgical Sciences, University of Oxford, Oxford OX1 2JD, UK.
Department of Hepatopancreatobiliary and Liver Transplant Surgery, Royal Free Hospital, Pond Street, Hampstead, London NW3 2QG, UK.
Int J Mol Sci. 2024 Apr 24;25(9):4648. doi: 10.3390/ijms25094648.
Liver transplantation (LT) is the only definitive treatment for end-stage liver disease, yet the UK has seen a 400% increase in liver disease-related deaths since 1970, constrained further by a critical shortage of donor organs. This shortfall has necessitated the use of extended criteria donor organs, including those with evidence of steatosis. The impact of hepatic steatosis (HS) on graft viability remains a concern, particularly for donor livers with moderate to severe steatosis which are highly sensitive to the process of ischaemia-reperfusion injury (IRI) and static cold storage (SCS) leading to poor post-transplantation outcomes. This review explores the pathophysiological predisposition of steatotic livers to IRI, the limitations of SCS, and alternative preservation strategies, including novel organ preservation solutions (OPS) and normothermic machine perfusion (NMP), to mitigate IRI and improve outcomes for steatotic donor livers. By addressing these challenges, the liver transplant community can enhance the utilisation of steatotic donor livers which is crucial in the context of the global obesity crisis and the growing need to expand the donor pool.
肝移植（LT）是治疗终末期肝病的唯一有效方法，但自 1970 年以来，英国因肝病相关的死亡人数增加了 400%，而供体器官的严重短缺进一步限制了这一治疗方法。这种短缺使得必须使用扩展标准供体器官，包括那些有脂肪变性证据的器官。肝脂肪变性（HS）对移植物活力的影响仍然是一个关注点，特别是对于中度至重度脂肪变性的供体肝脏，这些肝脏对缺血再灌注损伤（IRI）和静态冷保存（SCS）过程高度敏感，导致移植后结果不佳。这篇综述探讨了脂肪变性肝脏对 IRI 的病理生理易感性、SCS 的局限性，以及替代保存策略，包括新型器官保存溶液（OPS）和常温机器灌注（NMP），以减轻 IRI 并改善脂肪变性供体肝脏的结果。通过解决这些挑战，肝移植界可以提高脂肪变性供体肝脏的利用率，这在全球肥胖危机和扩大供体库的需求日益增长的背景下至关重要。
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