HOPE for human liver grafts obtained from donors after cardiac death
HOPE for human liver grafts obtained from donors after cardiac death
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DOI：
10.1016/j.jhep.2013.11.023
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发表时间：
2014-04-01
影响因子：
25.7
通讯作者：
Clavien, Pierre-Alain
中科院分区：
文献类型：
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作者：
Dutkowski, Philipp;Schlegel, Andrea;Clavien, Pierre-Alain
背景与目的：由于大多数国家的道德规范，在无心跳的供体器官获取之前，长时间缺血是不可避免的，这可能导致肝移植后早期移植物衰竭或晚期胆道狭窄。在移植物植入前使用低温充氧机灌注，可以挽救这些高危器官。方法：8例终末期肝病患者接受心脏控制性死亡（Maastricht分类III）后获得的人肝脏，供体中位热缺血时间为38 min，然后进行标准冷冲洗和4℃静态储存。在通过门静脉植入前1-2小时进行低温氧灌注（HOPE）。在10℃下冷却hope - perfusion，并使用ECOPS装置（Organ Assist (R)）充氧（pO(2) 60 kPa）。灌注压维持在3 mmHg以下。结果：各机器灌注肝移植术后早期功能良好。肝酶的释放和肾功能，以及ICU和住院时间与脑死亡供者的匹配肝移植物相当或更好。在中位8.5个月的随访中，未发现肝内胆道并发症的证据。结论：这是首次报道心脏骤停后移植的人肝冷机灌注。应用HOPE似乎耐受性好，易于使用，并保护早期和后期的伤害。(C) 2013欧洲肝脏研究协会。Elsevier b.v.版权所有。
Background & Aims: Due to ethical rules in most countries, long ischemia times are unavoidable prior to organ procurement of donors without a heartbeat, which can cause early graft failure after liver transplantation or late biliary strictures. Hypothermic oxygenated machine perfusion, used prior to graft implantation, may rescue these high risk organs.Methods: Eight patients with end stage liver diseases received human livers, obtained after controlled cardiac death (Maastricht category III), with a median donor warm ischemia time of 38 min, followed by a standard cold flush and static storage at 4 degrees C. Hypothermic oxygenated perfusion (HOPE) was applied for 1-2 h prior to implantation through the portal vein. The HOPE-perfusate was cooled at 10 degrees C and oxygenated (pO(2) 60 kPa) using an ECOPS device (Organ Assist (R)). Perfusion pressure was maintained below 3 mmHg.Results: Each machine perfused liver graft disclosed excellent early function after transplantation. The release of liver enzymes and kidney function, as well as ICU and hospital stays were comparable or better than in matched liver grafts from brain death donors. No evidence of intrahepatic biliary complications could be documented within a median follow up of 8.5 months.Conclusions: This is the first report on cold machine perfusion of human liver grafts obtained after cardiac arrest and subsequent transplantation. Application of HOPE appears well tolerated, easy-to-use, and protective against early and later injuries. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B. V. All rights reserved.