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肝脏移植评估的视角与工具:肝脏移植的变革时代

Perspectives and Tools in Liver Graft Assessment: A Transformative Era in Liver Transplantation.

作者信息

Safi Kawthar, Pawlicka Angelika Joanna, Pradhan Bhaskar, Sobieraj Jan, Zhylko Andriy, Struga Marta, Grąt Michał, Chrzanowska Alicja

机构信息

Department of Biochemistry, Medical University of Warsaw, 02-097 Warsaw, Poland.

1st Chair and Department of Cardiology, Medical University of Warsaw, 02-097 Warsaw, Poland.

出版信息

Biomedicines. 2025 Feb 17;13(2):494. doi: 10.3390/biomedicines13020494.

Abstract

Liver transplantation is a critical and evolving field in modern medicine, offering life-saving treatment for patients with end-stage liver disease and other hepatic conditions. Despite its transformative potential, transplantation faces persistent challenges, including a global organ shortage, increasing liver disease prevalence, and significant waitlist mortality rates. Current donor evaluation practices often discard potentially viable livers, underscoring the need for refined graft assessment tools. This review explores advancements in graft evaluation and utilization aimed at expanding the donor pool and optimizing outcomes. Emerging technologies, such as imaging techniques, dynamic functional tests, and biomarkers, are increasingly critical for donor assessment, especially for marginal grafts. Machine learning and artificial intelligence, exemplified by tools like LiverColor, promise to revolutionize donor-recipient matching and liver viability predictions, while bioengineered liver grafts offer a future solution to the organ shortage. Advances in perfusion techniques are improving graft preservation and function, particularly for donation after circulatory death (DCD) grafts. While challenges remain-such as graft rejection, ischemia-reperfusion injury, and recurrence of liver disease-technological and procedural advancements are driving significant improvements in graft allocation, preservation, and post-transplant outcomes. This review highlights the transformative potential of integrating modern technologies and multidisciplinary approaches to expand the donor pool and improve equity and survival rates in liver transplantation.

摘要

肝移植是现代医学中一个关键且不断发展的领域,为终末期肝病及其他肝脏疾病患者提供挽救生命的治疗。尽管具有变革潜力,但移植仍面临持续挑战,包括全球器官短缺、肝病患病率上升以及等待名单上的高死亡率。当前的供体评估做法常常舍弃潜在可用的肝脏,这凸显了改进移植物评估工具的必要性。本综述探讨了旨在扩大供体库并优化结果的移植物评估和利用方面的进展。诸如成像技术、动态功能测试和生物标志物等新兴技术对于供体评估日益关键,尤其是对于边缘性移植物。以LiverColor等工具为代表的机器学习和人工智能有望彻底改变供体 - 受体匹配及肝脏活力预测,而生物工程肝移植物为器官短缺提供了未来的解决方案。灌注技术的进步正在改善移植物的保存和功能,特别是对于心脏死亡后捐献(DCD)的移植物。尽管挑战依然存在,如移植物排斥、缺血 - 再灌注损伤和肝病复发,但技术和操作上的进步正在推动移植物分配、保存及移植后结果方面的显著改善。本综述强调了整合现代技术和多学科方法以扩大供体库并提高肝移植公平性和生存率的变革潜力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/4796/11852418/3b42d2c4f3c7/biomedicines-13-00494-g001.jpg

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