Association of Perfusion Characteristics and Posttransplant Liver Function in Ischemia-Free Liver Transplantation
Association of Perfusion Characteristics and Posttransplant Liver Function in Ischemia-Free Liver Transplantation
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DOI：
10.1002/lt.25825
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发表时间：
2020-11-01
影响因子：
4.6
通讯作者：
He, Xiaoshun
中科院分区：
文献类型：
--
作者：
Zhang, Zhiheng;Tang, Yunhua;He, Xiaoshun
研究表明，常温机器灌注（NMP）是一种新型保存方法，能够评估和复苏具有危险因素的肝移植物。然而，对于NMP肝移植的评估尚无一致的标准。无缺血肝移植（IFLT）包括创新的手术技术和NMP，可以在器官获取、保存和植入过程中保护肝移植物免受缺血。我中心于2017年7月至2018年10月期间对28例脑死亡捐献者的肝脏进行了IFLT，分析了移植后肝功能检测与灌注参数、灌注液血气分析、胆汁生化的相关性。保存阶段，血管血流稳定，乳酸水平迅速下降。灌注液中的转氨酶释放量低但稳定，而葡萄糖水平仍然很高。灌注 1 小时时的灌注液乳酸和天冬氨酸转氨酶 (AST) 水平与移植后 AST 峰值水平相关。灌注结束时门静脉和肝动脉流量与移植后7天内转氨酶峰值水平呈负相关。总之，在 IFLT 期间，NMP 能够在供体和受体之间架起肝移植桥梁，并可以通过灌注特性评估肝功能。
It has been shown that normothermic machine perfusion (NMP), a novel preservation method, is able to assess and resuscitate liver grafts with risk factors. However, there is no consistent criteria for the assessment of liver grafts with NMP. Ischemia-free liver transplantation (IFLT) includes innovative surgical techniques and NMP, which can protect liver grafts from ischemia throughout organ procurement, preservation, and implantation. In our center, 28 human livers from donation after brain death donors were subjected to IFLT between July 2017 and October 2018. The correlation between posttransplant liver function tests with the perfusion parameters, blood gas analysis of perfusate, and bile biochemistry were analyzed. During the preservation phase, the vascular flow was stable, and the lactate level decreased rapidly. The transaminase release in the perfusate was low but stable, whereas the glucose level remained high. The perfusate lactate and aspartate aminotransferase (AST) levels at 1 hour of perfusion were correlated with the posttransplant peak AST level. There were negative correlations between the portal vein and hepatic artery flows at the end of perfusion and the peak transaminase levels within 7 days after transplantation. In conclusion, during IFLT, NMP is able to bridge the liver grafts from donors to recipients and can allow the assessment of liver function by perfusion characteristics.