Jeddou Heithem, Tzedakis Stylianos, Chaouch Mohamed Ali, Sulpice Laurent, Samson Michel, Boudjema Karim
Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France.
Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Université de Rennes, Rennes, France.
Liver Int. 2025 Feb;45(2):e16244. doi: 10.1111/liv.16244.
The discrepancy between donor organ availability and demand leads to a significant waiting-list dropout rate and mortality. Although quantitative tools such as the Donor Risk Index (DRI) help assess organ suitability, many potentially viable organs are still discarded due to the lack of universally accepted markers to predict post-transplant outcomes. Normothermic machine perfusion (NMP) offers a platform to assess viability before transplantation. Thus, livers considered unsuitable for transplantation based on the DRI can be evaluated and potentially transplanted. During NMP, various viability criteria have been proposed. These criteria are neither homogeneous nor consensual. In this review, we aimed to describe the viability criteria during NMP and evaluate their ability to predict hepatic graft function following transplantation. We conducted a PubMed search using the terms 'liver transplantation', 'normothermic machine perfusion' and 'assessment', including only English publications up to February 2024. Viability assessment during NMP includes multiple hepatocellular and cholangiocellular criteria. Lactate clearance and bile production are commonly used indicators, but their ability to predict post-transplant outcomes varies significantly. The predictive value of cholangiocellular criteria such as bile pH, bicarbonate and glucose levels remains under investigation. Novel markers, such as microRNAs and proteomic profiles, offer the potential to enhance graft evaluation accuracy and provide insights into the molecular mechanisms underlying liver viability. Combining perfusion parameters with biomarkers may improve the prediction of long-term graft survival. Future research should focus on standardising viability assessment protocols and exploring real-time biomarker evaluations, which could enhance transplantation outcomes and expand the donor pool.
供体器官的可获得性与需求之间的差异导致了显著的等待名单退出率和死亡率。尽管诸如供体风险指数（DRI）等定量工具有助于评估器官的适用性，但由于缺乏普遍接受的预测移植后结果的标志物，许多潜在可行的器官仍被丢弃。常温机器灌注（NMP）提供了一个在移植前评估器官活力的平台。因此，基于DRI被认为不适合移植的肝脏可以得到评估并有可能进行移植。在NMP过程中，已经提出了各种活力标准。这些标准既不统一，也未达成共识。在本综述中，我们旨在描述NMP期间的活力标准，并评估它们预测移植后肝移植功能的能力。我们使用“肝移植”“常温机器灌注”和“评估”等术语在PubMed上进行了搜索，仅纳入截至2024年2月的英文出版物。NMP期间的活力评估包括多个肝细胞和胆管细胞标准。乳酸清除率和胆汁生成是常用指标，但它们预测移植后结果的能力差异很大。胆管细胞标准如胆汁pH值、碳酸氢盐和葡萄糖水平的预测价值仍在研究中。新型标志物，如微小RNA和蛋白质组学图谱，有可能提高移植物评估的准确性，并深入了解肝脏活力的分子机制。将灌注参数与生物标志物相结合可能会改善对长期移植物存活的预测。未来的研究应侧重于使活力评估方案标准化，并探索实时生物标志物评估，这可能会改善移植结果并扩大供体库。
