Subnormothermic Machine Perfusion for Ex Vivo Preservation and Recovery of the Human Liver for Transplantation

被引:183
作者
Bruinsma, B. G. [1 ,2 ]
Yeh, H. [3 ]
Oezer, S. [1 ]
Martins, P. N. [4 ]
Farmer, A. [1 ]
Wu, W. [1 ]
Saeidi, N. [1 ]
Op den Dries, S. [5 ]
Berendsen, T. A. [1 ]
Smith, R. N. [6 ]
Markmann, J. F. [3 ]
Porte, R. J. [5 ]
Yarmush, M. L. [1 ,7 ]
Uygun, K. [1 ]
Izamis, M. -L. [1 ]
机构
[1] Harvard Univ, Sch Med, Dept Surg, Ctr Engn Med,Massachusetts Gen Hosp, Boston, MA 02115 USA
[2] Univ Amsterdam, Acad Med Ctr, Dept Surg, Surg Lab, NL-1105 AZ Amsterdam, Netherlands
[3] Massachusetts Gen Hosp, Transplant Ctr, Boston, MA 02114 USA
[4] UMass Mem Med Ctr, Boston, MA USA
[5] Univ Groningen, Univ Med Ctr Groningen, Sect Hepatobiliary Surg & Liver Transplantat, Dept Surg, Groningen, Netherlands
[6] Massachusetts Gen Hosp, Dept Pathol, Boston, MA 02114 USA
[7] Rutgers State Univ, Dept Biomed Engn, Piscataway, NJ USA
基金
美国国家卫生研究院;
关键词
Donation after circulatory death; liver transplantation; organ preservation; subnormothermic machine perfusion; COLD-STORAGE; NORMOTHERMIC PRESERVATION; HOPE PROTECTS; DONOR LIVERS; BILE-DUCTS; INJURY; GRAFTS; VIABILITY; SURVIVAL; MODEL;
D O I
10.1111/ajt.12727
中图分类号
R61 [外科手术学];
学科分类号
摘要
To reduce widespread shortages, attempts are made to use more marginal livers for transplantation. Many of these grafts are discarded for fear of inferior survival rates or biliary complications. Recent advances in organ preservation have shown that ex vivo subnormothermic machine perfusion has the potential to improve preservation and recover marginal livers pretransplantation. To determine the feasibility in human livers, we assessed the effect of 3 h of oxygenated subnormothermic machine perfusion (21 degrees C) on seven livers discarded for transplantation. Biochemical and microscopic assessment revealed minimal injury sustained during perfusion. Improved oxygen uptake (1.30 [1.11-1.94] to 6.74 [4.15-8.16] mL O-2/min kg liver), lactate levels (4.04 [3.70-5.99] to 2.29 [1.20-3.43] mmol/L) and adenosine triphosphate content (45.0 [70.6-87.5] pmol/mg preperfusion to 167.5 [151.5-237.2] pmol/mg after perfusion) were observed. Liver function, reflected by urea, albumin and bile production, was seen during perfusion. Bile production increased and the composition of bile (bile salts/phospholipid ratio, pH and bicarbonate concentration) became more favorable. In conclusion, ex vivo subnormothermic machine perfusion effectively maintains liver function with minimal injury and sustains or improves various hepatobiliary parameters postischemia.
引用
收藏
页码:1400 / 1409
页数:10
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