Jiao Chunbao, Sun Keyue, Shamugarajah Kumaran, Zhang Mingyi, Wehrle Chase J, Panconesi Rebecca, Satish Sangeeta, Karakaya Omer, Fairchild Robert L, Hashimoto Koji, Miller Charles, Perez-Protto Silvia, Schlegel Andrea
Department of Inflammation and Immunity, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, USA.
Department of Hepatobiliary and Pancreatic Surgery, General Surgery Center, First Hospital of Jilin University, Changchun, China.
Hepatobiliary Surg Nutr. 2025 Aug 1;14(4):608-629. doi: 10.21037/hbsn-24-446. Epub 2025 Apr 15.
Hemadsorption, a therapeutic modality traditionally used to mitigate cytokine storm in critically ill patients and is now being tested in other medical fields including organ transplantation, especially for organs from extended criteria donors. Such organs are susceptible to ischemia-reperfusion injury (IRI) during transplantation, which is known to release a cascade of innate immune mediators including damage-associated molecular patterns (DAMPs) and cytokines during reperfusion and ultimately leading to graft dysfunction based on the metabolic injury. To address this challenge, early studies have integrated hemadsorption filters into organ perfusion circuits, such as normothermic regional perfusion (NRP) in donors and machine perfusion (MP) of grafts, with the aim to reduce inflammation and improve organ viability. While results indicated a benefit with this use, the data are limited, and the subcellular response mechanisms impacted by such filters remain unexplored. This narrative review explores the impact of hemadsorption devices from critical conditions to organ preservation, highlighting technical opportunities, benefits, current challenges, and potential effects on outcomes.
This review examines the application of hemadsorption in critically ill patients and in organ transplantation.
In complex clinical scenarios like sepsis and cardiac surgery, where systemic inflammatory responses are severe, hemadsorption alone may not be sufficient, requiring a comprehensive approach involving antimicrobial therapy, resuscitation, and immunomodulatory treatments to achieve immune homeostasis. In organ transplantation, hemadsorption shows potential benefits, but further clinical research is needed to optimize its use and to understand the impact of perfusates recirculating molecules on tissue metabolism during MP.
While hemadsorption requires thoughtful evaluation and adjunctive therapies in common critical clinical applications, it presents promising potential in the field of organ transplantation, particularly in organ preservation.
血细胞吸附是一种传统上用于减轻危重症患者细胞因子风暴的治疗方式，目前正在包括器官移植在内的其他医学领域进行试验，尤其是对于来自扩大标准供体的器官。此类器官在移植过程中易发生缺血再灌注损伤（IRI），已知在再灌注期间会释放一系列先天性免疫介质，包括损伤相关分子模式（DAMPs）和细胞因子，最终基于代谢损伤导致移植物功能障碍。为应对这一挑战，早期研究已将血细胞吸附滤器整合到器官灌注回路中，如供体的常温区域灌注（NRP）和移植物的机器灌注（MP），目的是减轻炎症并提高器官活力。虽然结果表明这种应用有益，但数据有限，且受此类滤器影响的亚细胞反应机制仍未得到探索。本叙述性综述探讨了血细胞吸附装置从危重症情况到器官保存的影响，强调了技术机遇、益处、当前挑战以及对结果的潜在影响。
本综述考察了血细胞吸附在危重症患者和器官移植中的应用。
在脓毒症和心脏手术等全身炎症反应严重的复杂临床场景中，单独的血细胞吸附可能不足，需要采取包括抗菌治疗、复苏和免疫调节治疗在内的综合方法来实现免疫稳态。在器官移植中，血细胞吸附显示出潜在益处，但需要进一步的临床研究来优化其使用，并了解MP期间灌注液再循环分子对组织代谢的影响。
虽然血细胞吸附在常见的关键临床应用中需要进行深思熟虑的评估和辅助治疗，但它在器官移植领域，特别是在器官保存方面具有广阔的潜力。
