Observations on the ex situ perfusion of livers for transplantation
Observations on the ex situ perfusion of livers for transplantation
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DOI：
10.1111/ajt.14687
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发表时间：
2018-08-01
影响因子：
8.8
通讯作者：
Butler, Andrew J.
中科院分区：
文献类型：
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作者：
Watson, Christopher J. E.;Kosmoliaptsis, Vasilis;Butler, Andrew J.
常温异位肝脏灌注可能允许在移植前评估肝脏的活力。研究了 47 例肝脏灌注的灌注特性，其中 22 例最终实现了移植。肝细胞损伤反映在灌注液转氨酶浓度上，其与移植后转氨酶峰值水平相关。 47 次灌注中有 46 次在 3 小时内发生乳酸清除，44 次灌注期间葡萄糖最初升高。三个肝脏需要更高水平的碳酸氢盐支持来维持生理 pH 值，其中一个肝脏正在发展为原发性无功能。胆汁产生与生存能力或胆管病无关，但在 22 个移植肝脏中的 16 个中测量的胆汁 pH 值，从那些未发生胆管病（pH > 7.5）的肝脏中识别出了 3 个发生胆管病（峰值 pH < 7.4）的肝脏。在可进行研究的 11 个研究肝脏中，胆汁 pH > 7.5 区分出 6 个肝脏表现出 > 50% 的间隔胆管周围间质坏死，而 4 个肝脏则没有坏死；一颗 25-50% 坏死的肝脏的最大 pH 值为 7.46。常温灌注期间的肝脏活力可以结合转氨酶释放、葡萄糖代谢、乳酸清除和酸碱平衡的维持来评估。胆汁 pH 值的评估可能为胆管完整性和移植后缺血性胆管病的风险提供有价值的见解。作者描述了一系列异位常温肝脏灌注，其中他们检查肝细胞和胆管细胞生物化学的生化标记，以预测移植后的活力。
Normothermic ex situ liver perfusion might allow viability assessment of livers before transplantation. Perfusion characteristics were studied in 47 liver perfusions, of which 22 resulted in transplants. Hepatocellular damage was reflected in the perfusate transaminase concentrations, which correlated with posttransplant peak transaminase levels. Lactate clearance occurred within 3hours in 46 of 47 perfusions, and glucose rose initially during perfusion in 44. Three livers required higher levels of bicarbonate support to maintain physiological pH, including one developing primary nonfunction. Bile production did not correlate with viability or cholangiopathy, but bile pH, measured in 16 of the 22 transplanted livers, identified three livers that developed cholangiopathy (peak pH < 7.4) from those that did not (pH > 7.5). In the 11 research livers where it could be studied, bile pH > 7.5 discriminated between the 6 livers exhibiting >50% circumferential stromal necrosis of septal bile ducts and 4 without necrosis; one liver with 25-50% necrosis had a maximum pH 7.46. Liver viability during normothermic perfusion can be assessed using a combination of transaminase release, glucose metabolism, lactate clearance, and maintenance of acid-base balance. Evaluation of bile pH may offer a valuable insight into bile duct integrity and risk of posttransplant ischemic cholangiopathy.The authors describe a series of ex situ normothermic liver perfusions in which they examine biochemical markers of hepatocyte and cholangiocyte biochemistry in an effort to predict posttransplant viability.