PDF(Pubmed)
Abstract：
Optimizing graft preservation is key for ex-situ split grafts in pediatric liver transplantation (PSLT). Hypothermic Oxygenated Perfusion (HOPE) improves ischemia-reperfusion injury (IRI) and post-operative outcomes in adult LT. This study compares the use of HOPE in ex-situ partial grafts to static cold storage ex-situ partial grafts (SCS-Split) and to the gold standard living donor liver transplantation (LDLT). All consecutive HOPE-Split, SCS-Split and LDLT performed between 2018-2023 for pediatric recipients were included. Post-reperfusion syndrome (PRS, drop ≥30% in systolic arterial pressure) and reperfusion biopsies served as early indicators of IRI. We included 47 pediatric recipients (15 HOPE-Split, 17 SCS-Split, and 15 LDLT). In comparison to SCS-Split, HOPE-Split had a significantly shorter cold ischemia time (CIT) (470min vs. 538 min; p =0.02), lower PRS rates (13.3% vs. 47.1%; p = 0.04) and a lower IRI score (3 vs. 4; p = 0.03). The overall IRI score (3 vs. 3; p = 0.28) and PRS (13.3% vs. 13.3%; p = 1) after HOPE-Split were comparable to LDLT, despite a longer CIT (470 min vs. 117 min; p < 0.001). Surgical complications, one-year graft, and recipient survival did not differ among the groups. In conclusion, HOPE-Split mitigates early IRI in pediatric recipients in comparison to SCS-Split, approaching the gold standard of LDLT.
摘要：
优化移植物保存是小儿肝移植（PSLT）中异位分裂移植物的关键。低温氧合灌注（HOPE）可改善成年LT的缺血再灌注损伤（IRI）和术后结局。这项研究比较了HOPE在非原位部分移植物中的使用，静态冷藏非原位部分移植物（SCS-Split）和金标准活体肝移植（LDLT）。所有连续的希望分裂，纳入了2018-2023年间为儿科接受者进行的SCS-Split和LDLT。再灌注后综合征（PRS，收缩压下降≥30％）和再灌注活检可作为IRI的早期指标。我们纳入了47名儿科受者(15名希望-分裂，17SCS-Split,和15LDLT）。与SCS-Split相比，HOPE-Split的冷缺血时间（CIT）明显较短（470minvs.538分钟；p=0.02)，较低的PRS率（13.3%与47.1%；p=0.04）和较低的IRI评分（3与4；p=0.03）。整体IRI得分（3vs.3；p=0.28）和PRS（13.3%与13.3%；p=1)在HOPE-Split后与LDLT相当，尽管CIT更长（470分钟vs.117分钟；p<0.001)。手术并发症,一年的移植，受者生存率在各组间无差异.总之,与SCS-Split相比，HOPE-Split减轻了儿科接受者的早期IRI，接近LDLT的黄金标准。
