人类供体肝脏常温机器灌注期间的灌注压力与体重减轻

Perfusion Pressures and Weight Loss During Normothermic Machine Perfusion of Human Donor Livers.

作者信息

Lascaris Bianca, Bodewes Silke B, Thorne Adam M, van den Heuvel Marius C, de Haas Robbert J, Nijsten Maarten W N, de Meijer Vincent E, Porte Robert J

机构信息

Department of Surgery, Section of Hepatobiliary Surgery and Liver Transplantation, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

Department of Pathology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.

出版信息

Artif Organs. 2025 May;49(5):820-830. doi: 10.1111/aor.14939. Epub 2024 Dec 31.

DOI:10.1111/aor.14939

PMID:39737605

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12019101/

Abstract

BACKGROUND

Normothermic machine perfusion (NMP) is increasingly used to preserve and assess donor livers prior to transplantation. Due to its success, it is expected that more centers will start using this technology. However, NMP may also cause adverse effects.

METHODS

In this retrospective, observational study, we investigated the effect of NMP pressures on donor liver weight, post-transplant outcomes, and hepatic perfusion characteristics. A total of 36 livers were transplanted after NMP. NMP perfusion pressure settings were lowered from a median (IQR) of 47 mmHg (42-54) to 34 mmHg (30-39) for the hepatic artery (HA), and from 8 mmHg (7-10) to 7 mmHg (6-8) for the portal vein (PV) to diminish potential edema formation inside the liver.

RESULTS

This change appeared to lead to a reduction of liver weight after NMP (-22 g to -143 g, p = 0.02), without affecting the PV flow velocity (35.5 to 48.0 cm/s, p = 0.54), or hepatocellular injury markers during NMP (AST 1511-1148 U/L, p = 0.44; ALT 318-849 U/L, p = 0.35), and post-transplantation outcomes. Changes in liver weight correlated significantly with the applied PV pressure during NMP (r = 0.52, p < 0.01) and the HA flow (r = 0.38, p < 0.05).

CONCLUSION

NMP can lead to a reduction in liver weight, which might be masked by edema when high perfusion pressures are used. We encourage applying the lowest perfusion pressures possible to reach adequate flows and oxygen supply during liver NMP.

摘要

背景

常温机器灌注（NMP）越来越多地用于在移植前保存和评估供体肝脏。由于其成功，预计会有更多中心开始使用这项技术。然而，NMP也可能产生不良影响。

方法

在这项回顾性观察研究中，我们调查了NMP压力对供体肝脏重量、移植后结局和肝脏灌注特征的影响。共有36例肝脏在NMP后进行了移植。肝动脉（HA）的NMP灌注压力设置从中位数（IQR）47 mmHg（42 - 54）降至34 mmHg（30 - 39），门静脉（PV）的灌注压力从8 mmHg（7 - 10）降至7 mmHg（6 - 8），以减少肝脏内部潜在的水肿形成。

结果

这种变化似乎导致NMP后肝脏重量减轻（-22 g至-143 g，p = 0.02），而不影响PV流速（35.5至48.0 cm/s，p = 0.54），或NMP期间的肝细胞损伤标志物（AST 1511 - 1148 U/L，p = 0.44；ALT 318 - 849 U/L，p = 0.35）以及移植后结局。肝脏重量的变化与NMP期间应用的PV压力（r = 0.52，p < 0.01）和HA流量（r = 0.38，p < 0.05）显著相关。