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[移植手术中的机器灌注]

[Machine perfusion in transplantation surgery].

作者信息

Kneifel Felicia, Vondran Florian, Vogel Thomas

机构信息

Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Münster, Münster, Deutschland.

Klinik für Allgemein‑, Viszeral‑, Kinder- und Transplantationschirurgie, RWTH Universitätsklinikum Aachen, Pauwelsstr. 30, 52074, Aachen, Deutschland.

出版信息

Chirurgie (Heidelb). 2024 Aug;95(8):610-617. doi: 10.1007/s00104-024-02122-w. Epub 2024 Jul 25.

Abstract

The use of machine perfusion in solid organ transplantation has developed tremendously worldwide in recent years. Although the number of randomized controlled trials in the field of organ preservation is still limited, machine perfusion has been shown to be superior to static cold storage of donor organs. Various devices for clinical use with hypothermia or normothermia are already available for most organs. Whether and which perfusion strategy is superior to the others is the subject of current clinical research. This also applies to the further evaluation of possible synergistic effects in the sequential use of the various protocols. The common goal of all dynamic perfusion technologies is to optimize organ preservation between removal and transplantation. By testing the quality of marginal donor organs prior to transplantation, it should also be possible to use these organs without exposing the patient to increased risk. This can lead to a significant expansion of the donor pool. This is particularly important in Germany, where there is an ongoing shortage of organs and restrictive legislation regarding the expansion of the donor pool. Furthermore, the perfusion technology offers the possibility to serve as a platform for other ex situ and in situ therapies on isolated organs. In addition to the conditioning of pre-damaged organs for transplantation, this could lead to further applications in the context of targeted organ therapies and also to improved transplant logistics in the future.

摘要

近年来,实体器官移植中机器灌注技术在全球范围内得到了极大的发展。尽管器官保存领域的随机对照试验数量仍然有限,但机器灌注已被证明优于供体器官的静态冷藏。目前,大多数器官都已有用于低温或常温的临床使用设备。哪种灌注策略是否优于其他策略是当前临床研究的课题。这也适用于对各种方案序贯使用中可能的协同效应的进一步评估。所有动态灌注技术的共同目标是优化器官在摘取和移植之间的保存。通过在移植前检测边缘供体器官的质量,也应该能够使用这些器官而不会使患者面临更高的风险。这可能会导致供体库的显著扩大。这在德国尤为重要,因为德国目前存在器官短缺问题,且关于扩大供体库的立法较为严格。此外,灌注技术还提供了作为其他离体和原位器官治疗平台的可能性。除了对预先受损的器官进行移植预处理外,这还可能在靶向器官治疗方面带来更多应用,并在未来改善移植物流。

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