Gierej Piotr, Radziszewski Marcin, Figiel Wojciech, Grąt Michał
Department of General Transplant and Liver Surgery, Medical University of Warsaw, 02-091 Warsaw, Poland.
J Clin Med. 2024 Jun 27;13(13):3762. doi: 10.3390/jcm13133762.
Orthotopic liver transplantation stands as the sole curative solution for end-stage liver disease. Nevertheless, the discrepancy between the demand and supply of grafts in transplant medicine greatly limits the success of this treatment. The increasing global shortage of organs necessitates the utilization of extended criteria donors (ECD) for liver transplantation, thereby increasing the risk of primary graft dysfunction (PGD). Primary graft dysfunction (PGD) encompasses early allograft dysfunction (EAD) and the more severe primary nonfunction (PNF), both of which stem from ischemia-reperfusion injury (IRI) and mitochondrial damage. Currently, the only effective treatment for PNF is secondary transplantation within the initial post-transplant week, and the occurrence of EAD suggests an elevated, albeit still uncertain, likelihood of retransplantation urgency. Nonetheless, the ongoing exploration of novel IRI mitigation strategies offers hope for future improvements in PGD outcomes. Establishing an intuitive and reliable tool to predict upcoming graft dysfunction is vital for early identification of high-risk patients and for making informed retransplantation decisions. Accurate diagnostics for PNF and EAD constitute essential initial steps in implementing future mitigation strategies. Recently, novel methods for PNF prediction have been developed, and several models for EAD assessments have been introduced. Here, we provide an overview of the currently scrutinized predictive tools for PNF and EAD evaluation strategies, accompanied by recommendations for future studies.
原位肝移植是终末期肝病的唯一治愈方法。然而，移植医学中供体供需之间的差异极大地限制了这种治疗方法的成功率。全球器官短缺日益严重，这使得在肝移植中必须使用边缘供体（ECD），从而增加了原发性移植肝功能障碍（PGD）的风险。原发性移植肝功能障碍（PGD）包括早期移植肝功能障碍（EAD）和更严重的原发性无功能（PNF），这两种情况均源于缺血再灌注损伤（IRI）和线粒体损伤。目前，PNF的唯一有效治疗方法是在移植后的第一周内进行二次移植，而EAD的发生表明再次移植紧迫性增加，尽管这种可能性仍不确定。尽管如此，对新型IRI缓解策略的持续探索为未来改善PGD结果带来了希望。建立一个直观且可靠的工具来预测即将发生的移植肝功能障碍，对于早期识别高危患者以及做出明智的再次移植决策至关重要。对PNF和EAD进行准确诊断是实施未来缓解策略的重要初始步骤。最近，已经开发出了用于预测PNF的新方法，并且引入了几种用于评估EAD的模型。在此，我们概述了目前用于PNF评估和EAD评估策略的经过审查的预测工具，并对未来的研究提出了建议。
