Successful extracorporeal porcine liver perfusion for 72 hr
Successful extracorporeal porcine liver perfusion for 72 hr
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DOI：
10.1097/00007890-200204270-00005
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发表时间：
2002-04-27
期刊：
影响因子：
6.2
通讯作者：
Friend, PJ
中科院分区：
文献类型：
--
作者：
Butler, AJ;Rees, MA;Friend, PJ
背景。体外灌注技术的改进和抗超急性排斥的转基因猪的生产刺激了一些研究小组重新探索用体外猪肝支持肝功能衰竭患者的可能性。器官移植的成功也激发了使用体外灌注作为器官保存和边缘供体器官复苏手段的兴趣。本研究描述了一种方法，通过这种方法，肝脏可以在正常的体外灌注条件下维持至少72小时。进行5次体外猪肝灌注，每次持续72小时。进行肝切除术，随后进行冷藏保存，血管插管，并开始用常温、含氧的猪血灌注。通过代谢、合成、血流动力学和组织学参数评估器官活力。经72小时的恒温体外灌注后，离体肝脏的pH值和电解质维持在正常的生理水平。肝蛋白合成（补体和因子V）在整个灌注过程中保持持续。血流动力学参数保持在正常生理范围内。组织学显示肝脏保存良好，无整体结构改变。在体外灌注至少72小时的情况下，肝脏有可能保持存活状态。这项技术主要是作为体外肝支持的临床前模型开发的，目的是在暴发性肝衰竭患者中进行临床试验。然而，它在器官保存或移植前复苏以及离体肝脏生理学的实验研究中也有潜在的应用。
Background. Improvements in extracorporeal perfusion technology and the production of transgenic pigs resistant to hyperacute rejection have stimulated several groups to re-explore the possibility of supporting patients in hepatic failure with extracorporeal porcine livers. The success of organ transplantation has also stimulated interest in using extracorporeal perfusion as a means of organ preservation and resuscitation of organs from marginal donors. The present study describes a method by which livers can be maintained in a viable condition for a minimum of 72 hr of normothermic, extracorporeal perfusion.Methods. Five extracorporeal porcine liver perfusions were performed, each with a duration of 72 hr. Hepatectomy was performed, followed by cold preservation, cannulation of vessels, and initiation of perfusion with normothermic, oxygenated porcine blood. Organ viability was assessed by metabolic, synthetic, hemodynamic, and histologic parameters.Results. After 72 hr of normothermic, extracorporeal perfusion, the isolated livers demonstrated maintenance of normal physiological levels of pH and electrolytes. Continued hepatic protein synthesis (complement and factor V) was maintained throughout the perfusion. Hemodynamic parameters remained within normal physiological range. Histology demonstrated good preservation of the liver with no overall architectural change.Conclusion. It is possible to maintain a liver in a viable condition for a minimum of 72 hr of extracorporeal perfusion. This technique has been developed primarily as a preclinical model of extracorporeal liver support with the intention of proceeding to a clinical trial in patients with fulminant liver failure. However, it also has potential applications in organ preservation or resuscitation before transplantation and in the experimental study of isolated liver physiology.