Development of a liver viability index for transplantation

摘要 在美国，慢性肝病和肝硬变每年导致6万人死亡，其中超过4000人是 直接由于缺乏可供移植的供体肝脏。这些数字可能会大幅减少。 是否应该通过提供边缘病例来扩大供体器官库，例如心脏手术后获得的供体 死亡(DCD)，可移植。据估计，每年约有6000具身体肝脏仅轻微受损 心脏缺血后死亡，并可复苏进行移植。有来自我们实验室的证据 和其他人认为机器灌流是一种非常有希望的恢复身体器官的方法，这将是 否则就会被排除在捐赠者名单之外。然而，临床上安全有效地实现了这样一种机器 灌流设备需要复杂的算法来确保严格控制系统，最大限度地提高 并在灌流结束时准确评估肝脏是否为移植做好准备。那里 是为评估器官移植的存活率而设计的方法和算法的显著差距。 量化和客观的方式，这是临床翻译边缘器官恢复的一大瓶颈 技术和该领域的垂直进步。 我们的长期目标是最大限度地利用捐献器官，同时确保移植成功。 移植。这项研究的目的是开发和测试一种动态的、在线的评估肝脏的方法。 移植手术在一项小型临床研究中获得成功。这里要检验的中心假设是肝脏存活 移植后与其能量状态及机器灌流过程中的能量代谢有关。 本文描述的工作有望创建一个动态的、在线的肝脏存活评分，该评分可用于 在移植手术前评估供体器官的状况，最终减少猜测 参与移植，从而增加对边际捐献器官的使用，减少因 导致移植失败。这一进展有望加快临床采用机器灌流的步伐。 肝脏以及其他器官的保存研究。这项工作的成果也将产生积极的影响 建立工艺设计与控制一体化的基础对工程科学的影响 复杂、动态的器官保存系统。

ABSTRACT Chronic liver disease and cirrhosis causes up 60,000 deaths annually in the US, over 4,000 of which are directly due to lack of a donor liver available for transplant. These numbers could be reduced dramatically should the donor organ pool be expanded by rendering marginal cases, such as Donors obtained after Cardiac Death (DCD), transplantable. It is estimated that about 6,000 cadaveric livers/yr are only marginally damaged by ischemia post-cardiac death and could be resuscitated for transplantation. There is evidence from our lab and others that machine perfusion is a very promising approach for recovering cadaveric organs that would be otherwise rejected from the donor pool. However, safe and effective clinical realization of such a machine perfusion device requires sophisticated algorithms that ensure tight control of the system, maximize the viability of the organ and accurately assess if the liver is ready for transplantation at the end of perfusion. There is a significant gap of methods and algorithms designed for assessing organ viability for transplantation in a quantitative and objective manner, which is a major bottleneck in clinical translation of marginal organ recovery technologies and vertical advancement of the field. Our long-term goal is to maximize the use of donor organs while ensuring the graft success upon transplant. The objective of the proposed study is to develop and test a dynamic, online method to assess liver transplant success in a small clinical study. The central hypothesis to be tested here is that the liver survival post-transplantation is correlated to its energy state and energy metabolism during machine perfusion. The work described here is expected to create a dynamic, on-line liver viability score which can be used to assess the condition of the donor organs prior to transplantation surgery, ultimately reducing the guesswork involved in transplantation and consequently increasing the use of marginal donor organs reducing deaths due to graft failure. This development is anticipated to increase the pace of clinical adoption of machine perfusion preservation studies for the liver, as well as other organs. The results of this work will also have a positive impact on engineering science by establishing the basis for integration of process design & control of these complex, dynamic organ preservation systems.