Controlled Oxygenated Rewarming of Cold Stored Liver Grafts by Thermally Graduated Machine Perfusion Prior to Reperfusion
Controlled Oxygenated Rewarming of Cold Stored Liver Grafts by Thermally Graduated Machine Perfusion Prior to Reperfusion
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DOI：
10.1111/ajt.12235
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发表时间：
2013-06-01
影响因子：
8.8
通讯作者：
Lueer, B.
中科院分区：
文献类型：
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作者：
Minor, T.;Efferz, P.;Lueer, B.
冷藏肝脏的质量随着缺血时间的延长而下降，增加原发性功能障碍或无功能的风险。研究了一种在血液再灌注前通过温和的含氧预热来拯救保留的边缘肝移植物的新概念。将猪肝脏在改良的 HTK 溶液中冷藏 (CS) 保存 18 小时。随后通过机器灌注将一些移植物进行90分钟的受控氧合复温(COR)，将灌注液温度逐渐升高至20℃，或者在低温(HMP)或亚常温(SNP)下进行简单氧合机器灌注。此后通过离体常温血液再灌注4小时来评估移植物活力。 COR 或 SNP 显着改善了缺血组织能量学，而 HMP 的改善程度明显较小。 COR 显着减少细胞酶损失、基因表达和 TNF-α 的灌注液活性、自由基介导的脂质过氧化 (LPO) 以及再灌注时门脉血管灌注阻力的增加，而 HMP 或 SNP 的保护作用较差。与 CS 相比，只有 COR 才会产生显着更多的胆汁产生。 COR 后的组织学损伤评分和 caspase 3 激活显着低于 CS 后。再灌注前的氧合复温似乎是一种有前途的技术，可改善长期保存的肝移植物再灌注后的后续器官恢复。
The quality of cold-stored livers declines with the extension of ischemic time, increasing the risk of primary dys or nonfunction. A new concept to rescue preserved marginal liver grafts by gentle oxygenated warming-up prior to blood reperfusion was investigated. Porcine livers were preserved by cold storage (CS) in modified HTK-solution for 18h. Some grafts were subsequently subjected to 90min of controlled oxygenated rewarming (COR) by machine perfusion with gradual increase of perfusate temperature up to 20 degrees C or simple oxygenated machine perfusion in hypothermia (HMP) or subnormothermia (SNP). Graft viability was assessed thereafter by 4h of normothermic blood reperfusion ex vivo. Endischemic tissue energetics were significantly improved by COR or SNP and to a notably lesser extent by HMP. COR significantly reduced cellular enzyme loss, gene expression and perfusate activities of TNF-alpha, radical mediated lipid peroxidation (LPO) and increase of portal vascular perfusion resistance upon reperfusion, while HMP or SNP were less protective. Only COR resulted in significantly more bile production than after CS. Histological injury score and caspase 3-activation were significantly lower after COR than after CS. Oxygenated rewarming prior to reperfusion seems to be a promising technique to improve subsequent organ recovery upon reperfusion of long preserved liver grafts.