A Back-to-Base Experience of Human Normothermic Ex Situ Liver Perfusion: Does the Chill Kill?
A Back-to-Base Experience of Human Normothermic Ex Situ Liver Perfusion: Does the Chill Kill?
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DOI：
10.1002/lt.25464
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发表时间：
2019-06-01
影响因子：
4.6
通讯作者：
Shapiro, A. M. James
中科院分区：
文献类型：
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作者：
Bral, Mariusz;Dajani, Khaled;Shapiro, A. M. James
在一项随机对照试验中，常温机器灌注（NMP）已被证明可以保护肝脏免受采购和移植之间的损伤，其中机器被运送到供体中心和从供体中心运送。本研究的目的是确定是否有一种替代的，更实用的回基地的方法后，最初的静态冷藏将损害有益的结果。2015年2月至2018年6月期间，在一家临床试验机构进行了一项非随机初步研究。将肝脏回基（n = 26）的结果与接受即刻NMP的局部移植物（n = 17）的结果进行比较。主要结局指标（安全性）定义为30天患者和移植物存活率。共使用NMP灌注了46个肝移植物，其中3个基于离体灌注功能差而被丢弃。回基地和当地NMP组的30天患者和移植物存活率均为100%（主要结局：安全性）。尽管平均冷缺血时间显著延长（6 vs 3.2小时; P = 0.001），但回基肝脏在移植物功能、并发症发生率或移植物和患者存活率方面没有差异。总之，回基地的方法是安全的，没有损害NMP的整体效益，并提供了一个实用的替代便携式常温异地机器运输。
Normothermic machine perfusion (NMP) has been shown to protect livers from injury between procurement and transplantation in a randomized controlled trial, where the machine was transported to and from the donor center. The aim of this study was to determine whether an alternative, more practical back-to-base approach after initial static cold storage would compromise beneficial outcomes. Between February 2015 and June 2018, a nonrandomized pilot study was performed at a single site. Outcomes of back-to-base livers (n = 26) were compared with those of grafts procured locally that underwent immediate NMP (n = 17). The primary outcome measure (safety) was defined as 30-day patient and graft survival. A total of 46 liver grafts were perfused with NMP, of which 3 were discarded based on poor ex situ perfusion function. The 30-day patient and graft survival in the back-to-base and local NMP groups were both 100% (primary outcome: safety). Despite significantly prolonged mean cold ischemia time (6 versus 3.2 hours; P = 0.001), the back-to-base livers demonstrated no difference in graft function, incidence of complications, or graft and patient survival. In conclusion, the back-to-base approach was safe, did not compromise the overall benefit of NMP, and offers a practical alternative to portable normothermic ex situ machine transport.