Abstract：
As an alternative to static cold storage (SCS), advanced perfusion techniques such as normothermic regional perfusion and ex-situ perfusion (normothermic or hypothermic) have emerged as a way to improve the ischemic injury suffered by donation after circulatory death (DCD) livers. Multiple studies have been published that have demonstrated superior post-DCD liver transplant outcomes when using advanced perfusion compared with SCS. In particular, these studies have shown lower rates of ischemic cholangiopathy with advanced perfusion. In addition to the improved post-liver transplant outcomes, studies have also demonstrated higher rates of liver utilization from DCD donors when advanced perfusion is used compared with SCS. Given the high rates of graft loss in patients who develop ischemic cholangiopathy, the significant reduction seen in DCD donor livers that have undergone advanced perfusion represents a key step in more broad utilization of these livers. With such compelling evidence from multiple trials, it seems reasonable to ask the question: should advanced perfusion be the standard of care for DCD liver transplant?
摘要：
作为静态冷存储（SCS）的替代方案，先进的灌注技术，例如常温区域灌注（NRP）和非原位灌注（常温或低温）已成为改善DCD肝脏缺血性损伤的一种方法。已经发表了多项研究，这些研究表明，与SCS相比，使用高级灌注时，DCD后的肝移植结果更优越。特别是,这些研究显示晚期灌注的缺血性胆管病变发生率较低.除了改善肝移植后的结果，研究还表明，与SCS相比，使用高级灌注时，DCD供体的肝脏利用率更高。鉴于发生缺血性胆管病变的患者移植物丢失率高，在DCD供体肝脏经历了晚期灌注的显着减少，代表了更广泛利用这些肝脏的关键步骤。有了来自多个试验的令人信服的证据，问这个问题似乎是合理的：先进的灌注应该是DCD肝移植的标准治疗吗？
