Division of Transplant Surgery, Department of Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
Artif Organs. 2024 Nov;48(11):1275-1287. doi: 10.1111/aor.14812. Epub 2024 Jul 22.
Efforts to improve the quality of marginal grafts for transplantation are essential. Machine perfusion preservation appears as a promising solution.
The United Network for Organ Sharing (UNOS) database was queried for deceased liver donor records between 2016 and 2022. The primary outcome of interest was the organ nonutilization rate. Long-term graft and patient survival among extended criteria donors (ECDs) were also analyzed.
During the study period, out of 54 578 liver grafts recovered for transplant, 5085 (9.3%) were nonutilized. Multivariable analysis identified normothermic machine perfusion (NMP) preservation as the only predictor associated with a reduction in graft nonutilization (OR = 0.12; 95% CI = 0.06-0.023, p < 0.001). Further analysis of ECD grafts that were transplanted revealed comparable 1-,2- and 3-years graft survival (89%/88%/82% vs. 90%/85%/81%, p = 0.60), and patient survival (92%/91%/84% vs. 92%/88%/84%, p = 0.65) between grafts that underwent MP vs. those who did not, respectively.
Liver nonutilization rates in the United States are at an all-time high. Available data, most likely including cases from clinical trials, showed that NMP reduced the odds of organ nonutilization by 12% among the entire deceased donor pool and by 16% among grafts from ECD. Collective efforts and further evidence reflecting day-to-day clinical practice are needed to fully reach the potential of MP for liver transplant.
努力提高移植用边缘供体的质量至关重要。机器灌注保存似乎是一种很有前途的解决方案。
本研究检索了 2016 年至 2022 年期间美国器官共享联合网络（UNOS）数据库中已故肝供体的记录。主要观察终点是器官未利用率。还分析了扩展标准供体（ECD）的长期移植物和患者存活率。
在研究期间，在 54578 例用于移植的肝移植物中，有 5085 例（9.3%）未被利用。多变量分析确定常温机器灌注（NMP）保存是唯一与降低移植物未利用率相关的预测因素（OR=0.12；95%CI=0.06-0.023，p<0.001）。对接受移植的 ECD 移植物进一步分析显示，1、2 和 3 年移植物存活率相当（89%/88%/82% vs. 90%/85%/81%，p=0.60），患者存活率（92%/91%/84% vs. 92%/88%/84%，p=0.65）分别在接受 MP 的移植物和未接受 MP 的移植物之间。
美国的肝未利用率处于历史最高水平。现有数据（可能包括临床试验中的病例）表明，NMP 使整个已故供体库的器官未利用率降低了 12%，ECD 供体的器官未利用率降低了 16%。需要共同努力并提供更多反映日常临床实践的证据，以充分发挥 MP 在肝移植中的潜力。
