Current state of hypothermic machine perfusion preservation of organs: The clinical perspective.
Current state of hypothermic machine perfusion preservation of organs: The clinical perspective.
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DOI：
10.1016/j.cryobiol.2009.10.006
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发表时间：
2010-07
期刊：
影响因子：
2.7
通讯作者：
Baicu, Simona C
中科院分区：
文献类型：
--
作者：
Taylor, Michael J;Baicu, Simona C
这篇综述的重点是低温灌注技术的应用，作为一个当前感兴趣的话题，有可能对提高供体器官的数量和质量以及移植结果的临床挑战产生有益的影响。移植前在机器上对供体器官进行体外灌注，而不是在冰上静态冷藏，这不是一个新想法，但由于有可能获得更多更好的移植器官，因此正在重新考虑。研究灌注技术的基本原理将与肾移植临床结果和经济效益相关的新数据进行讨论。还将参考正在进行的使用其他器官的研究，特别强调胰腺的节段性胰腺和孤立胰岛移植。器官低温机器灌注的预期和新出现的好处是：1)维持血管床的通畅，2)提供营养物和低需氧量，以支持降低能量需求，3)清除代谢副产物和毒素，4)提供细胞保护剂和/或免疫调节药物的使用途径，5)增加可用的器官活力评估和组织匹配检测方法，6)促进从急诊手术转向择期手术，降低成本，改善结果。vii)通过降低PNF和DGF参数来改善临床结果，viii)改善ECD肾脏或来自NHBD的器官的稳定或挽救，从而增加供体池的规模，ix)为移植中心带来显著的经济效益并降低医疗成本，以及x)为药物开发研究提供非移植人体器官的离体使用技术。
This review focuses on the application of hypothermic perfusion technology as a topic of current interest with the potential to have a salutary impact on the mounting clinical challenges to improve the quantity and quality of donor organs and the outcome of transplantation. The ex vivo perfusion of donor organs on a machine prior to transplant, as opposed to static cold storage on ice, is not a new idea but is being re-visited because of the prospects of making available more and better organs for transplantation. The rationale for pursuing perfusion technology will be discussed in relation to emerging data on clinical outcomes and economic benefits for kidney transplantation. Reference will also be made to on-going research using other organs with special emphasis on the pancreas for both segmental pancreas and isolated islet transplantation. Anticipated and emerging benefits of hypothermic machine perfusion of organs are: i) maintaining the patency of the vascular bed, ii) providing nutrients and low demand oxygen to support reduced energy demands, iii) removal of metabolic by-products and toxins, iv) provision of access for administration of cytoprotective agents and/or immunomodulatory drugs, v) increase of available assays for organ viability assessment and tissue matching, vi) facilitation of a change from emergency to elective scheduled surgery with reduced costs and improved outcomes, vii) improved clinical outcomes as demonstrated by reduced PNF and DGF parameters, viii) improved stabilization or rescue of ECD kidneys or organs from NHBD that increase the size of the donor pool, ix) significant economic benefit for the transplant centers and reduced health care costs, and x) provision of a technology for ex vivo use of non-transplanted human organs for pharmaceutical development research.