Zhylko Andriy, Morawski Marcin, Rykowski Paweł, Krasnodębski Maciej, Wyporski Anya, Borkowski Jan, Zhylko Dmytro, Kobryń Konrad, Stankiewicz Rafał, Stypułkowski Jan, Hołówko Wacław, Patkowski Waldemar, Wróblewski Tadeusz, Szczepankiewicz Benedykt, Górnicka Barbara, Mielczarek-Puta Magdalena, Struga Marta, Krawczyk Marek, Grąt Michał
Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Banacha 1A, 02-097 Warsaw, Poland.
Doctoral School, Medical University of Warsaw, 02-091 Warsaw, Poland.
J Clin Med. 2025 Jan 13;14(2):471. doi: 10.3390/jcm14020471.
: Hypothermic oxygenated machine perfusion has emerged as a strategy to alleviate ischemic-reperfusion injury in liver grafts. Nevertheless, there is limited data on the effectiveness of hypothermic liver perfusion in evaluating organ quality. This study aimed to introduce a readily accessible real-time predictive biomarker measured in machine perfusate for post-transplant liver graft function. : The study evaluated perfusate analytes over a 90-day postoperative period in 26 patients randomly assigned to receive a liver graft following dual hypothermic machine perfusion in a prospective randomized controlled trial. Machine perfusion was consistently conducted end-ischemically for at least 120 min, with real-time perfusate assessment at 30-min intervals. Graft functionality was assessed using established metrics, including Early Allograft Dysfunction (EAD). : Perfusate lactate concentration after 120 min of machine perfusion demonstrated significant predictive value for EAD (AUC ROC: 0.841, = 0.009). Additionally, it correlated with post-transplant peak transaminase levels and extended hospital stays. Subgroup analysis revealed significantly higher lactate accumulation in livers with post-transplant EAD. : Liver graft quality can be effectively assessed during hypothermic machine perfusion using simple perfusate lactate measurements. The reliability and accessibility of this evaluation support its potential integration into diverse transplant centers.
低温氧合机器灌注已成为减轻肝移植缺血再灌注损伤的一种策略。然而，关于低温肝脏灌注在评估器官质量方面有效性的数据有限。本研究旨在引入一种易于获取的实时预测生物标志物，该标志物可在机器灌注液中测量，用于预测移植后肝移植功能。
该研究在一项前瞻性随机对照试验中，对26例随机分配接受双低温机器灌注后肝移植的患者进行了为期90天的术后灌注液分析物评估。机器灌注在缺血末期持续进行至少120分钟，每隔30分钟对灌注液进行实时评估。使用包括早期移植物功能障碍（EAD）在内的既定指标评估移植物功能。
机器灌注120分钟后的灌注液乳酸浓度对EAD具有显著预测价值（AUC ROC：0.841，P = 0.009）。此外，它与移植后转氨酶峰值水平及住院时间延长相关。亚组分析显示，移植后发生EAD的肝脏中乳酸积累显著更高。
通过简单测量灌注液乳酸，可在低温机器灌注期间有效评估肝移植质量。该评估的可靠性和可及性支持其有可能整合到不同的移植中心。
