Normothermic Machine Perfusion of Deceased Donor Liver Grafts Is Associated With Improved Postreperfusion Hemodynamics.
Normothermic Machine Perfusion of Deceased Donor Liver Grafts Is Associated With Improved Postreperfusion Hemodynamics.
复制标题
DOI：
10.1097/txd.0000000000000611
复制
发表时间：
2016-09
影响因子：
2.3
通讯作者：
Mirza DF
中科院分区：
文献类型：
--
作者：
Angelico R;Perera MT;Ravikumar R;Holroyd D;Coussios C;Mergental H;Isaac JR;Iqbal A;Cilliers H;Muiesan P;Friend PJ;Mirza DF
移植物再灌注是肝移植过程中的一个关键挑战，可能与血流动力学不稳定/再灌注后综合征有关。这是缺血再灌注损伤的结果，常温机械保存（NMP）可能影响血流动力学变化。在此，我们描述了NMP和传统冷保存后移植肝再灌注后的血流动力学特征。比较了NMP（n = 6; NMP组）和冷藏（CS）（n = 12; CS组）后接受移植物的患者的术中记录。平均动脉压（MAP）定义为1个心动周期内桡动脉的平均压力。再灌注后综合征定义为MAP下降大于基线的30%，在移植物再灌注的前5分钟内持续1分钟或更长时间。供体、受体、人口统计学和手术参数均匹配。常温机保存移植物在初始冷缺血时间91分钟（73-117分钟）后灌注525分钟（395-605分钟），而CS组冷缺血时间为456分钟（347-685分钟）（P = 0.001）。NMP组无一例发生再灌注后综合征，CS组n = 2例（16.7%）（P = 0.529）。与CS组相比，常温机保存组在再灌注后90 min时的MAP更好（P = 0.029），血管加压药的需要量更少（P = <0.05），血制品的输注量更少（P = 0.030）。常温机器灌注与再灌注后稳定的术中血流动力学特征相关，在移植物再灌注后需要显著减少血管加压剂输注和血液制品输注，并且可能有利于减轻肝移植中的缺血再灌注损伤。
Graft reperfusion poses a critical challenge during liver transplantation and can be associated with hemodynamic instability/postreperfusion syndrome. This is sequel to ischemia-reperfusion injury and normothermic machine preservation (NMP) may affect hemodynamic changes. Herein, we characterize postreperfusion hemodynamics in liver grafts after NMP and traditional cold preservation. Intraoperative records of patients receiving grafts after NMP (n = 6; NMP group) and cold storage (CS) (n = 12; CS group) were compared. The mean arterial pressure (MAP) was defined as the average pressure in the radial artery during 1 cardiac cycle by invasive monitoring. Postreperfusion syndrome was defined as MAP drop greater than 30% of baseline, lasting for 1 minute or longer within the first 5 minutes from graft reperfusion. Donor, recipient, demographics, and surgical parameters were evenly matched. Normothermic machine preservation grafts were perfused for 525 minutes (395-605 minutes) after initial cold ischemic time of 91 minutes (73-117 minutes), whereas in CS group cold ischemic time was 456 minutes (347-685 minutes) (P = 0.001). None developed postreperfusion syndrome in the NMP group against n = 2 (16.7%) in CS group (P = 0.529). Normothermic machine preservation group had better intraoperative MAP at 90 minutes postreperfusion (P = 0.029), achieved with a significantly less vasopressor requirement (P = <0.05) and less transfusion of blood products (P = 0.030) compared with CS group. Normothermic machine perfusion is associated with a stable intraoperative hemodynamic profile postreperfusion, requiring significantly less vasopressor infusions and blood product transfusion after graft reperfusion and may have benefit to alleviate ischemia-reperfusion injury in liver transplantation.