■采购后,肝移植物暴露于缺血期,该缺血期响应于氧剥夺而引发多种病理生理变化。因此,器官保存过程中的目标是减弱这种反应,并提供足够的环境,为移植后的代谢再激活做好准备。这已经通过静态冷藏保存广泛实现,其中使用冷保存溶液维持移植物降低其代谢活性并赋予细胞保护直到移植。然而,尽管是器官保存的黄金标准,静态冷库有几个缺点。此外,持续的器官短缺导致使用非常规移植物,这些移植物可以从移植前的治疗中受益。通过机器灌注系统保存器官似乎是解决这两者的有希望的解决方案。
■这里,我们的目标是提出一个国家的最先进的叙事审查关于使用机器灌注系统结合辅助策略,包括免疫调节肝移植修改方案,基因治疗和药物治疗。
■现有的报告很少,而且大多是关于实验动物模型的。考虑到这些特定类型的机器允许代谢活跃的器官,大多数文献反映了常温或低温机器灌注设备的使用。因此便于修改。虽然有限,现有报告中的有希望的发现表明,使用机器灌注系统保存器官,当与替代疗法结合使用时,对于移植物修饰是可行且安全的策略。
■需要对临床环境进行进一步研究,以更好地阐明移植前移植物修饰对短期和长期移植物和患者存活的真正影响。制定指南并批准这些新疗法用于临床实践还有很长的路要走。然而,这条路看起来很有希望。
UNASSIGNED: Following procurement, the liver graft is exposed to an ischemic period that triggers several pathophysiologic changes in response to oxygen deprivation. Therefore, the goal during organ preservation is to attenuate such response and provide an adequate environment that prepares the graft for its metabolic reactivation following implantation. This has been widely achieved via static cold storage preservation, where the maintenance of the graft using cold preservation solutions reduce its metabolic activity and confer cytoprotection until transplantation. However, despite being the gold standard for organ preservation, static cold storage holds several disadvantages. In addition, the ongoing organ shortage has led to the use of unconventional grafts that could benefit from therapies pre-transplant. Organ preservation via machine perfusion systems appears as a promising solution to address both.
UNASSIGNED: Here, we aim to present a state-of-the-art narrative review regarding liver graft modification options using machine perfusion systems in combination with adjuvant strategies including immunomodulation, gene therapy and pharmacotherapy.
UNASSIGNED: Available reports are scarce and mostly on experimental animal models. Most of the literature reflects the use of normothermic or subnormothermic machine perfusion devices given that these particular type of machine allows for a metabolically active organ, and therefore facilitates its modification. Although limited, promising findings in available reports suggest that organ preservation using machine perfusion system when combined with alternative therapies can be feasible and safe strategies for graft modification.
UNASSIGNED: Further research on clinical settings are needed to better elucidate the true effect of graft modification pre-transplant on short- and long-term graft and patient survival. There is a long way ahead to develop guidelines and approve these novel therapies for clinical practice. However, the path looks promising.