Abstract：
Outcome data for the great majority of liver normothermic machine perfusion (NMP) cases derive from the strict confines of clinical trials. Detailed specifics regarding the intraoperative and early postoperative impact of NMP on reperfusion injury and its sequelae during real-world use of this emerging technology remain largely unavailable.
We analyzed transplants performed in a 3-month pilot period during which surgeons invoked commercial NMP at their discretion. Living donor, multi-organ, and hypothermic machine perfusion transplants were excluded.
Intraoperatively, NMP (n = 24) compared to static cold storage (n = 25) recipients required less peri-reperfusion bolus epinephrine (0 vs. 60 μg; p < .001) and post-reperfusion fresh frozen plasma (2.5 vs. 7.0 units; p = .0069), platelets (.0 vs. 2.0 units; p = .042), and hemostatic agents (0% vs. 24%; p = .010). Time from incision to venous reperfusion did not differ (3.6 vs. 3.1; p = .095) but time from venous reperfusion to surgery end was shorter for NMP recipients (2.3 vs. 2.8 h; p = .0045). Postoperatively, NMP recipients required fewer red blood cell (1.0 vs. 4.0 units; p = .0083) and fresh frozen plasma (4.0 vs. 7.0 units; p = .046) transfusions, had shorter intensive care unit stays (33.5 vs. 58.4 h; p = .012), and experienced less early allograft dysfunction according to both the Model for Early Allograft Function Score (3.4 vs. 5.0; p = .0047) and peak AST within 10 days of transplant (619 vs. 1,181 U/L; p = .036). Liver acceptance for the corresponding recipient was conditional on NMP use for 63% (15/24) of cases.
Real-world NMP use was associated with significantly lower intensity of reperfusion injury and intraoperative and postoperative care that may translate into patient benefit.
We analyzed transplants performed in a 3-month pilot period during which surgeons invoked commercial NMP at their discretion. Living donor, multi-organ, and hypothermic machine perfusion transplants were excluded.
Intraoperatively, NMP (n = 24) compared to static cold storage (n = 25) recipients required less peri-reperfusion bolus epinephrine (0 vs. 60 μg; p < .001) and post-reperfusion fresh frozen plasma (2.5 vs. 7.0 units; p = .0069), platelets (.0 vs. 2.0 units; p = .042), and hemostatic agents (0% vs. 24%; p = .010). Time from incision to venous reperfusion did not differ (3.6 vs. 3.1; p = .095) but time from venous reperfusion to surgery end was shorter for NMP recipients (2.3 vs. 2.8 h; p = .0045). Postoperatively, NMP recipients required fewer red blood cell (1.0 vs. 4.0 units; p = .0083) and fresh frozen plasma (4.0 vs. 7.0 units; p = .046) transfusions, had shorter intensive care unit stays (33.5 vs. 58.4 h; p = .012), and experienced less early allograft dysfunction according to both the Model for Early Allograft Function Score (3.4 vs. 5.0; p = .0047) and peak AST within 10 days of transplant (619 vs. 1,181 U/L; p = .036). Liver acceptance for the corresponding recipient was conditional on NMP use for 63% (15/24) of cases.
Real-world NMP use was associated with significantly lower intensity of reperfusion injury and intraoperative and postoperative care that may translate into patient benefit.
摘要：
背景：绝大多数肝脏常温机械灌注（NMP）病例的结果数据来自临床试验的严格限制。关于NMP对再灌注损伤的术中和术后早期影响及其在现实世界中使用该新兴技术的后遗症的详细细节仍然在很大程度上不可用。
方法：我们分析了在3个月的试验期内进行的移植，在此期间，外科医生会自行决定调用商业NMP。活着的捐赠者，多器官,排除低温机器灌注移植。
结果：术中，与静态冷藏（n=25）相比，NMP（n=24）接受者需要更少的围再灌注推注肾上腺素（0vs.60μg；p<.001）和再灌注后新鲜冷冻血浆（2.5vs.7.0个单位；p=.0069)，血小板（.0vs.2.0个单位；p=.042)，和止血剂(0%vs.24%；p=.010）。从切口到静脉再灌注的时间没有差异（3.6vs.3.1；p=.095），但NMP接受者从静脉再灌注到手术结束的时间较短（2.3vs.2.8小时；p=.0045）。术后,NMP接受者需要更少的红细胞（1.0vs.4.0单位；p=.0083）和新鲜冷冻血浆（4.0vs.7.0单位；p=.046）输血，重症监护病房住院时间较短(33.5vs.58.4小时；p=.012)，根据早期同种异体移植功能评分模型，早期同种异体移植功能障碍较少（3.4vs.5.0；p=.0047），并在移植后10天内达到AST峰值（619vs.1181U/L；p=0.036）。相应接受者的肝脏接受以63%(15/24)的病例使用NMP为条件。
结论：现实世界中使用NMP与显著降低再灌注损伤强度以及术中和术后护理相关，这可能会转化为患者的益处。
方法：我们分析了在3个月的试验期内进行的移植，在此期间，外科医生会自行决定调用商业NMP。活着的捐赠者，多器官,排除低温机器灌注移植。
结果：术中，与静态冷藏（n=25）相比，NMP（n=24）接受者需要更少的围再灌注推注肾上腺素（0vs.60μg；p<.001）和再灌注后新鲜冷冻血浆（2.5vs.7.0个单位；p=.0069)，血小板（.0vs.2.0个单位；p=.042)，和止血剂(0%vs.24%；p=.010）。从切口到静脉再灌注的时间没有差异（3.6vs.3.1；p=.095），但NMP接受者从静脉再灌注到手术结束的时间较短（2.3vs.2.8小时；p=.0045）。术后,NMP接受者需要更少的红细胞（1.0vs.4.0单位；p=.0083）和新鲜冷冻血浆（4.0vs.7.0单位；p=.046）输血，重症监护病房住院时间较短(33.5vs.58.4小时；p=.012)，根据早期同种异体移植功能评分模型，早期同种异体移植功能障碍较少（3.4vs.5.0；p=.0047），并在移植后10天内达到AST峰值（619vs.1181U/L；p=0.036）。相应接受者的肝脏接受以63%(15/24)的病例使用NMP为条件。
结论：现实世界中使用NMP与显著降低再灌注损伤强度以及术中和术后护理相关，这可能会转化为患者的益处。
