Ischaemia-free liver transplantation in humans: a first-in-human trial

被引：37

作者：

Guo, Zhiyong ^{[1
,2
,3
]}

Zhao, Qiang ^{[1
,2
,3
]}

Huang, Shanzhou ^{[1
,2
,3
]}

Huang, Changjun ^{[1
,2
,3
]}

Wang, Dongping ^{[1
,2
,3
]}

Yang, Lu ^{[4
]}

Zhang, Jian ^{[5
]}

Chen, Maogen ^{[1
,2
,3
]}

Wu, Linwei ^{[1
,2
,3
]}

Zhang, Zhiheng ^{[1
,2
,3
]}

Zhu, Zebin ^{[1
,2
,3
]}

Wang, Linhe ^{[1
,2
,3
]}

Zhu, Caihui ^{[1
,2
,3
]}

Zhang, Yixi ^{[1
,2
,3
]}

Tang, Yunhua ^{[1
,2
,3
]}

Sun, Chengjun ^{[1
,2
,3
]}

Xiong, Wei ^{[4
]}

Shen, Yuekun ^{[4
]}

Chen, Xiaoxiang ^{[4
]}

Xu, Jinghong ^{[1
,2
,3
]}

Wang, Tielong ^{[1
,2
,3
]}

Ma, Yi ^{[1
,2
,3
]}

Hu, Anbin ^{[1
,2
,3
]}

Chen, Yinghua ^{[1
,2
,3
]}

Zhu, Xiaofeng ^{[1
,2
,3
]}

Rong, Jian ^{[6
]}

Cai, Changjie ^{[7
]}

Gong, Fengqiu ^{[8
]}

Guan, Xiangdong ^{[7
]}

Huang, Wenqi ^{[4
]}

Ko, Dicken Shiu-Chung ^{[9
]}

Li, Xianchang ^{[1
,2
,3
,10
]}

Tullius, Stefan G. ^{[11
]}

Huang, Jiefu ^{[1
,12
]}

Ju, Weiqiang ^{[1
,2
,3
]}

He, Xiaoshun ^{[1
,2
,3
]}

机构：

[1] Sun Yat Sen Univ, Affiliated Hosp 1, Organ Transplant Ctr, 58 Zhongshan Er Rd, Guangzhou 510080, Peoples R China

[2] Guangdong Prov Key Lab Organ Donat & Transplant I, Guangzhou 510080, Peoples R China

[3] Guangdong Prov Int Cooperat Base Sci & Technol Or, Guangzhou 510080, Peoples R China

[4] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Anaesthesiol, Guangzhou 510080, Peoples R China

[5] Sun Yat Sen Univ, Zhongshan Ophthalm Ctr, State Key Lab Ophthalmol, Guangzhou 510080, Peoples R China

[6] Sun Yat Sen Univ, Affiliated Hosp 1, Dept Cardiopulm Bypass, Guangzhou 510080, Peoples R China

[7] Sun Yat Sen Univ, Affiliated Hosp 1, Surg Intens Care Unit, Guangzhou 510080, Peoples R China

[8] Sun Yat Sen Univ, Affiliated Hosp 1, Operating Room & Anaesthesia Ctr, Guangzhou 510080, Peoples R China

[9] Tufts Univ, Sch Med, Steward St Elizabeths Med Ctr, Dept Surg, Boston, MA 02115 USA

[10] Houston Methodist Res Inst, Immunobiol & Transplant Sci Ctr, Houston, TX 77030 USA

[11] Harvard Med Sch, Brigham & Womens Hosp, Div Transplant Surg, Boston, MA 02115 USA

[12] Peking Union Med Coll Hosp, Dept Surg, Beijing 100032, Peoples R China

来源：

LANCET REGIONAL HEALTH-WESTERN PACIFIC | 2021年 / 16卷

基金：

中国国家自然科学基金;

关键词：

HYPOTHERMIC MACHINE PERFUSION; EARLY ALLOGRAFT DYSFUNCTION; EX-VIVO PRESERVATION; NORMOTHERMIC PERFUSION; COLD-STORAGE; HEART-TRANSPLANTATION; ORGAN-TRANSPLANTATION; CIRCULATORY DEATH; CRITERIA DONORS; COMPLICATIONS;

D O I：

10.1016/j.lanwpc.2021.100260

中图分类号：

R19 [保健组织与事业（卫生事业管理）];

学科分类号：

摘要：

Background Ischaemia-reperfusion injury is considered an inevitable component of organ transplantation, compromising organ quality and outcomes. Although several treatments have been proposed, none has avoided graft ischaemia and its detrimental consequences. Methods Ischaemia-free liver transplantation (IFLT) comprises surgical techniques enabling continuous oxygenated blood supply to the liver of brain-dead donor during procurement, preservation, and implantation using normothermic machine perfusion technology. In this non-randomised study, 38 donor livers were transplanted using IFLT and compared to 130 conventional liver transplants (CLT). Findings Two recipients (5.3%) in the IFLT group experienced early allograft dysfunction, compared to 50.0% in patients receiving conventional transplants (absolute risk difference, 44.8%; 95% confidence interval, 33.6-55.9%). Recipients of IFLT had significantly reduced median (IQR) peak aspartate aminotransferase levels within the first week compared to CLT recipients (365, 238-697 vs 1445, 791-3244 U/L, p<0.001); likewise, median total bilirubin levels on day 7 were significantly lower (2.34, 1.39-4.09 mg/dL) in the IFLT group than in the CLT group (5.10, 1.90-11.65 mg/dL) (p<0.001). Moreover, IFLT recipients had a shorter median intensive care unit stay (1.48, 0.75-2.00 vs 1.81, 1.00-4.58 days, p=0.006). Both one-month recipient (97.4% vs 90.8%, p=0.302) and graft survival (97.4% vs 90.0%, p=0.195) were better for IFLT than CLT, albeit differences were not statistically significant. Subgroup analysis showed that the extended criteria donor livers transplanted using the IFLT technique yielded faster post-transplant recovery than did the standard criteria donor livers transplanted using the conventional approach. Interpretation IFLT provides a novel approach that may improve outcomes, and allow the successful utilisation of extended criteria livers. (C) 2021 The Author(s). Published by Elsevier Ltd.

引用

页数：10

共 36 条

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