Abstract：
Given the susceptibility of organs to ischaemic injury, alternative preservation methods to static cold storage (SCS), such as normothermic machine perfusion (NMP) are emerging. The aim of this study was to perform a comparison between NMP and SCS in liver transplantation with particular attention to bile duct lesions.
The outcomes of 59 consecutive NMP-preserved donor livers were compared in a 1 : 1 propensity score-matched fashion to SCS control livers. Postoperative complications, patient survival, graft survival and bile duct lesions were analysed.
While patients were matched for cold ischaemia time, the total preservation time was significantly longer in the NMP group (21 h versus 7 h, P < 0.001). Patient and graft survival rates at 1 year were 81 versus 82 per cent (P = 0.347) and 81 versus 79 per cent (P = 0.784) in the NMP and SCS groups, respectively. The postoperative complication rate was comparable (P = 0.086); 37 per cent NMP versus 34 per cent SCS patients had a Clavien-Dindo grade IIIb or above complication. There was no difference in early (30 days or less) (NMP 22 versus SCS 19 per cent, P = 0.647) and late (more than 30 days) (NMP 27 versus SCS 36 per cent, P = 0.321) biliary complications. However, NMP-preserved livers developed significantly fewer ischaemic-type bile duct lesions (NMP 3 versus SCS 14 per cent, P = 0.047).
The use of NMP allowed for a significantly prolonged organ preservation with a lower rate of observed ischaemic-type bile duct lesions.
The outcomes of 59 consecutive NMP-preserved donor livers were compared in a 1 : 1 propensity score-matched fashion to SCS control livers. Postoperative complications, patient survival, graft survival and bile duct lesions were analysed.
While patients were matched for cold ischaemia time, the total preservation time was significantly longer in the NMP group (21 h versus 7 h, P < 0.001). Patient and graft survival rates at 1 year were 81 versus 82 per cent (P = 0.347) and 81 versus 79 per cent (P = 0.784) in the NMP and SCS groups, respectively. The postoperative complication rate was comparable (P = 0.086); 37 per cent NMP versus 34 per cent SCS patients had a Clavien-Dindo grade IIIb or above complication. There was no difference in early (30 days or less) (NMP 22 versus SCS 19 per cent, P = 0.647) and late (more than 30 days) (NMP 27 versus SCS 36 per cent, P = 0.321) biliary complications. However, NMP-preserved livers developed significantly fewer ischaemic-type bile duct lesions (NMP 3 versus SCS 14 per cent, P = 0.047).
The use of NMP allowed for a significantly prolonged organ preservation with a lower rate of observed ischaemic-type bile duct lesions.
摘要：
鉴于器官对缺血损伤的易感性，静态冷藏（SCS）的替代保存方法，如常温机灌注(NMP)正在兴起。这项研究的目的是比较肝移植中NMP和SCS之间的差异，特别注意胆管病变。
以1:1倾向评分匹配的方式将59个连续NMP保存的供体肝脏的结果与SCS对照肝脏进行比较。术后并发症,患者生存,移植物存活和胆管病变进行了分析。
虽然患者的冷缺血时间相匹配，NMP组的总保存时间明显更长(21h对7h，P<0.001)。NMP和SCS组患者和移植物1年生存率分别为81对82%(P=0.347)和81对79%(P=0.784),分别。术后并发症发生率相当（P=0.086）；37％的NMP和34％的SCS患者有Clavien-DindoIIIb级或以上的并发症。早期（30天或更短）没有差异（NMP22与SCS19％，P=0.647）和延迟（超过30天）（NMP27与SCS36％，P=0.321)胆道并发症。然而,保留NMP的肝脏发生的缺血性胆管病变明显减少（NMP3与SCS14％，P=0.047)。
使用NMP可以明显延长器官保存时间，观察到的缺血型胆管病变的发生率较低。
以1:1倾向评分匹配的方式将59个连续NMP保存的供体肝脏的结果与SCS对照肝脏进行比较。术后并发症,患者生存,移植物存活和胆管病变进行了分析。
虽然患者的冷缺血时间相匹配，NMP组的总保存时间明显更长(21h对7h，P<0.001)。NMP和SCS组患者和移植物1年生存率分别为81对82%(P=0.347)和81对79%(P=0.784),分别。术后并发症发生率相当（P=0.086）；37％的NMP和34％的SCS患者有Clavien-DindoIIIb级或以上的并发症。早期（30天或更短）没有差异（NMP22与SCS19％，P=0.647）和延迟（超过30天）（NMP27与SCS36％，P=0.321)胆道并发症。然而,保留NMP的肝脏发生的缺血性胆管病变明显减少（NMP3与SCS14％，P=0.047)。
使用NMP可以明显延长器官保存时间，观察到的缺血型胆管病变的发生率较低。
