常温机器灌注改善心脏死亡后供体长时间热缺血异体移植物的捐献结局。
Normothermic Machine Perfusion Improves Outcomes for Donation After Cardiac Death Allografts With Extended Donor Warm Ischemia Time.
作者信息
Li Xingjie, Chang Yu-Hui, Ohara Stephanie Y, Reddy Kunam S, Jadlowiec Caroline C, Mathur Amit K, Nguyen Michelle C
机构信息
Department of Surgery, Division of Transplant Surgery, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
Department of Quantitative Health Sciences, Mayo Clinic Arizona, Scottsdale, Arizona, USA.
出版信息
Clin Transplant. 2025 Mar;39(3):e70133. doi: 10.1111/ctr.70133.
INTRODUCTION
Donation after circulatory death (DCD) allografts are underutilized in liver transplantation (LT) due to increased risk of complications. These risks stem from ischemic injury sustained during the total donor warm ischemia time (tDWIT), historically limited to 30 min. Normothermic machine perfusion (NMP) can mitigate these risks and facilitate LT of DCD grafts with extended tDWIT. We aimed to compare outcomes of DCD allografts with extended tDWIT preserved on NMP versus static cold storage (SCS).
METHODS
This single-center study included adult DCD LT with tDWIT ≥ 30 from 2019 to 2023. Outcomes of NMP and SCS were compared including EAD, IC, graft survival, and patient survival.
RESULTS
Among 68 DCD LT with tDWIT ≥ 30, 64.7% (n = 44) were preserved with NMP and 35.3% (n = 24) with SCS. No differences in donor or recipient demographics were observed. The median tDWIT was 33 min for NMP and 30.5 min for SCS (p < 0.01). Despite longer tDWIT, the NMP group had lower rates of EAD (4.5% vs. 66.7%, p < 0.01) and IC (2.3% vs. 29.2%, p < 0.01). One-year graft survival was higher in NMP (p < 0.01), and 1-year patient survival was comparable between groups (p = 0.18).
CONCLUSION
NMP challenges traditional tDWIT constraints and can increase the pool of viable DCD allografts for transplantation.
引言
由于并发症风险增加，心脏死亡后器官捐献（DCD）的同种异体移植物在肝移植（LT）中的利用率较低。这些风险源于在总的供体热缺血时间（tDWIT）期间遭受的缺血性损伤，以往该时间限制在30分钟以内。常温机器灌注（NMP）可以减轻这些风险，并有助于延长tDWIT的DCD移植物进行肝移植。我们旨在比较在NMP与静态冷藏（SCS）条件下保存的延长tDWIT的DCD同种异体移植物的结局。
方法
这项单中心研究纳入了2019年至2023年tDWIT≥30分钟的成年DCD肝移植患者。比较了NMP和SCS的结局，包括原发性无功能（EAD）、缺血性胆管病变（IC）、移植物存活和患者存活情况。
结果
在68例tDWIT≥30分钟的DCD肝移植患者中，64.7%（n = 44）采用NMP保存，35.3%（n = 24）采用SCS保存。供体或受体的人口统计学特征未见差异。NMP组的tDWIT中位数为33分钟，SCS组为30.5分钟（p < 0.01）。尽管tDWIT更长，但NMP组的EAD发生率较低（4.5%对66.7%，p < 0.01），IC发生率也较低（2.3%对29.2%，p < 0.01）。NMP组的1年移植物存活率更高（p < 0.01），两组间1年患者存活率相当（p = 0.18）。
结论
NMP对传统的tDWIT限制提出了挑战，并可增加可用于移植的存活DCD同种异体移植物的数量。
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