低温机器灌注与肝移植短期预后改善相关：一项回顾性队列研究
Hypothermic Machine Perfusion Is Associated with Improved Short-Term Outcomes in Liver Transplantation: A Retrospective Cohort Study.
作者信息
Nastase Alexandru Grigorie, Vasilescu Alin Mihai, Trofin Ana Maria, Zabara Mihai, Cadar Ramona, Vasiluta Ciprian, Vlad Nutu, Ciuntu Bogdan Mihnea, Lupascu Ursulescu Corina, Muzica Cristina, Girleanu Irina, Buzincu Iulian, Iftimie Florin, Lupascu Cristian Dumitru
机构信息
Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy, 700115 Iasi, Romania.
General Surgery and Liver Transplant Clinic, St. Spiridon University Hospital, 700111 Iasi, Romania.
出版信息
Life (Basel). 2025 Jul 16;15(7):1112. doi: 10.3390/life15071112.
INTRODUCTION
Liver transplantation remains the definitive treatment for end-stage liver disease but faces critical challenges including organ shortages and preservation difficulties, particularly with extended criteria donor (ECD) grafts. Hypothermic machine perfusion (HMP) represents a promising alternative to traditional static cold storage (SCS).
METHODS
This retrospective study analyzed outcomes from 62 liver transplant recipients between 2016 and 2025, comparing 8 grafts preserved by HMP using the Liver Assist system and 54 grafts preserved by SCS. Parameters assessed included postoperative complications, hemodynamic stability, ischemia times, and survival outcomes.
RESULTS
HMP significantly reduced surgical (0% vs. 75.9%, = 0.01) and biliary complications (0% vs. 34.4%, = 0.004), improved hemodynamic stability post-reperfusion (∆MAP%: 1 vs. 21, = 0.006), and achieved superior one-year survival rates (100% vs. 84.4%). Despite longer ischemia periods, grafts treated with HMP exhibited fewer adverse effects from ischemia-reperfusion injury.
DISCUSSION
These findings highlight the substantial benefits of HMP, particularly in improving graft quality from marginal donors and reducing postoperative morbidity. Further adoption of this technology could significantly impact liver transplantation outcomes by expanding the viable donor pool.
CONCLUSIONS
The study underscores the effectiveness of hypothermic machine perfusion (HMP) as a superior preservation method compared to traditional static cold storage (SCS), HMP appears to be associated with improved short-term outcomes in liver transplantation. By substantially reducing postoperative complications and enhancing graft viability, HMP emerges as a pivotal strategy for maximizing the use of marginal donor organs. Further research and broader clinical implementation are recommended to validate these promising results and to fully harness the potential of HMP in liver transplantation.
引言
肝移植仍然是终末期肝病的确定性治疗方法，但面临着包括器官短缺和保存困难等关键挑战，尤其是对于边缘供体（ECD）移植物而言。低温机器灌注（HMP）是传统静态冷藏（SCS）的一种有前景的替代方法。
方法
这项回顾性研究分析了2016年至2025年间62例肝移植受者的结局，比较了使用肝脏辅助系统通过HMP保存的8个移植物和通过SCS保存的54个移植物。评估的参数包括术后并发症、血流动力学稳定性、缺血时间和生存结局。
结果
HMP显著降低了手术并发症（0%对75.9%，P = 0.01）和胆道并发症（0%对34.4%，P = 0.004），改善了再灌注后的血流动力学稳定性（平均动脉压变化百分比：1对21，P = 0.006），并实现了更高的一年生存率（100%对84.4%）。尽管缺血时间更长，但接受HMP处理的移植物缺血再灌注损伤的不良反应更少。
讨论
这些发现突出了HMP的显著益处，特别是在改善边缘供体移植物质量和降低术后发病率方面。进一步采用这项技术可能通过扩大可行供体库而显著影响肝移植结局。
结论
该研究强调了低温机器灌注（HMP）作为一种优于传统静态冷藏（SCS）的保存方法的有效性，HMP似乎与肝移植中更好的短期结局相关。通过大幅降低术后并发症并提高移植物活力，HMP成为最大限度利用边缘供体器官的关键策略。建议进行进一步研究和更广泛的临床应用，以验证这些有前景的结果，并充分发挥HMP在肝移植中的潜力。
Zotero 插件