PDF(Pubmed)
Abstract：
Traditional liver transplant strategies with cold preservation usually result in ischemia-reperfusion injury (IRI) to the donor liver. Regular normothermic machine perfusion (NMP) donor livers suffer IRI twice. Here, we aimed to introduce a novel technique called continuous NMP without recooling to avoid a second IRI and its application in livers from extended criteria donors.
Seven donor livers transplanted following continuous NMP without recooling, 7 donor livers transplanted following standard NMP, and 14 livers under static cold storage (SCS) were included in this study. Perioperative outcomes were recorded and analyzed between groups.
During the NMP without a recooling procedure, all livers cleared lactate quickly to normal levels in a median time of 100 min (interquartile range, 60-180) and remained stable until the end of perfusion. In the NMP without recooling and standard NMP groups, posttransplant peak aspartate aminotransferase and alanine aminotransferase levels were both significantly lower than those in the SCS group (P = 0.0015 and 0.016, respectively). The occurrence rate of early allograft dysfunction was significantly lower in the NMP without recooling group than in the SCS group (P = 0.022), whereas there was no difference in the NMP group with or without recooling (P = 0.462).
Our pilot study revealed a novel technique designed to avoid secondary IRI. This novel technique is shown to have at least a comparable effect on the standard NMP, although more data are needed to show its superiority in the future.
Seven donor livers transplanted following continuous NMP without recooling, 7 donor livers transplanted following standard NMP, and 14 livers under static cold storage (SCS) were included in this study. Perioperative outcomes were recorded and analyzed between groups.
During the NMP without a recooling procedure, all livers cleared lactate quickly to normal levels in a median time of 100 min (interquartile range, 60-180) and remained stable until the end of perfusion. In the NMP without recooling and standard NMP groups, posttransplant peak aspartate aminotransferase and alanine aminotransferase levels were both significantly lower than those in the SCS group (P = 0.0015 and 0.016, respectively). The occurrence rate of early allograft dysfunction was significantly lower in the NMP without recooling group than in the SCS group (P = 0.022), whereas there was no difference in the NMP group with or without recooling (P = 0.462).
Our pilot study revealed a novel technique designed to avoid secondary IRI. This novel technique is shown to have at least a comparable effect on the standard NMP, although more data are needed to show its superiority in the future.
摘要：
传统的冷保存肝移植策略通常会导致供肝缺血再灌注损伤（IRI）。常规的常温机器灌注（NMP）供体肝脏两次遭受IRI。这里,我们的目标是引入一种新的技术,称为连续NMP,无需再冷却,以避免第二次IRI,并将其应用于来自扩展标准供体的肝脏.
连续NMP后移植的七个供体肝脏没有再冷却，在标准NMP后移植的7个供体肝脏，本研究包括14例静态冷藏（SCS）下的肝脏。记录并分析组间的围手术期结果。
在没有再合并过程的NMP期间，所有肝脏在100分钟的中位时间内将乳酸迅速清除至正常水平(四分位距，60-180），并保持稳定，直到灌注结束。在没有再合并和标准NMP组的NMP中，移植后天门冬氨酸转氨酶和丙氨酸转氨酶峰值水平均显著低于SCS组(P分别为0.0015和0.016).NMP无复诊组早期移植功能障碍发生率明显低于SCS组(P=0.022),而NMP组伴或不伴复诊无差异(P=0.462)。
我们的初步研究揭示了一种旨在避免继发性IRI的新技术。这项新技术被证明对标准NMP具有至少相当的效果，尽管未来需要更多数据来显示其优越性。
连续NMP后移植的七个供体肝脏没有再冷却，在标准NMP后移植的7个供体肝脏，本研究包括14例静态冷藏（SCS）下的肝脏。记录并分析组间的围手术期结果。
在没有再合并过程的NMP期间，所有肝脏在100分钟的中位时间内将乳酸迅速清除至正常水平(四分位距，60-180），并保持稳定，直到灌注结束。在没有再合并和标准NMP组的NMP中，移植后天门冬氨酸转氨酶和丙氨酸转氨酶峰值水平均显著低于SCS组(P分别为0.0015和0.016).NMP无复诊组早期移植功能障碍发生率明显低于SCS组(P=0.022),而NMP组伴或不伴复诊无差异(P=0.462)。
我们的初步研究揭示了一种旨在避免继发性IRI的新技术。这项新技术被证明对标准NMP具有至少相当的效果，尽管未来需要更多数据来显示其优越性。
