Subnormothermic machine perfusion for ex vivo preservation and recovery of the human liver for transplantation.
Subnormothermic machine perfusion for ex vivo preservation and recovery of the human liver for transplantation.
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DOI：
10.1111/ajt.12727
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发表时间：
2014-06
期刊：
影响因子：
--
通讯作者：
Izamis ML
中科院分区：
文献类型：
--
作者：
Bruinsma BG;Yeh H;Ozer S;Martins PN;Farmer A;Wu W;Saeidi N;Op den Dries S;Berendsen TA;Smith RN;Markmann JF;Porte RJ;Yarmush ML;Uygun K;Izamis ML
为了减少广泛的短缺，人们试图使用更多的边缘肝脏进行移植。由于担心存活率较低或胆道并发症，许多移植物被丢弃。器官保存的最新进展表明，离体亚常温机器灌注具有改善保存和恢复移植前边缘肝脏的潜力。为了确定在人类肝脏中的可行性，我们评估了3小时的充氧亚常温机器灌注（21 °C）对7个被丢弃用于移植的肝脏的影响。生化和显微镜评估显示灌注过程中持续的损伤最小。观察到氧摄取（1.30 [1.11-1.94]至6.74 [4.15-8.16] mL O2/min.kg liver）、乳酸水平（4.04 [3.70-6.00]至2.29 [1.20-3.42] mmol/L）和三磷酸腺苷含量（灌注前45.0 [70.6-87.5]至灌注后167.5 [151.5-237.2] pmol/mg）改善。在灌注期间观察到通过尿素、白蛋白和胆汁生成反映的肝功能。胆汁产量增加，胆汁组成（胆汁盐/磷脂比、pH值和碳酸氢盐浓度）变得更有利。总之，离体亚常温机器灌注有效地维持肝功能，损伤最小，并维持或改善缺血后的各种肝胆参数。
To reduce widespread shortages, attempts are made to use more marginal livers for transplantation. Many of these grafts are discarded for fear of inferior survival rates or biliary complications. Recent advances in organ preservation have shown that ex vivo subnormothermic machine perfusion has the potential to improve preservation and recover marginal livers pre- transplantation. To determine the feasibility in human livers, we assessed the effect of 3 hours of oxygenated subnormothermic machine perfusion (21 °C) on seven livers discarded for transplantation. Biochemical and microscopic assessment revealed minimal injury sustained during perfusion. Improved oxygen uptake (1.30 [1.11–1.94] to 6.74 [4.15–8.16] mL O2/min.kg liver), lactate levels (4.04 [3.70–6.00] to 2.29 [1.20–3.42] mmol/L) and adenosine triphosphate content (45.0 [70.6–87.5] pre-perfusion to 167.5 [151.5–237.2] pmol/mg after perfusion) were observed. Liver function, reflected by urea, albumin and bile production was seen during perfusion. Bile production increased and the composition of bile (bile salts/phospholipid ratio, pH and bicarbonate concentration) became more favorable. In conclusion, ex vivo subnormothermic machine perfusion effectively maintains liver function with minimal injury and sustains or improves various hepatobiliary parameters post-ischemia.
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