Application of dual hypothermic oxygenated machine perfusion in ex vivo split liver transplantation
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摘要: 随着劈离式肝移植的飞速开展,其技术日趋成熟。离体劈离时,由于细胞内能量来源[如三磷酸腺苷(ATP)]的耗竭以及其他代谢紊乱,导致细胞损伤和功能障碍,这种损伤会因肝移植再灌注损伤而加重,临床上表现为移植术后并发症和移植失败。为了进一步改善离体劈离式肝移植的供肝质量,国内外研究团队使用机械灌注来改善供肝质量。本文结合了国际上离体劈离式肝移植供肝机械灌注的研究进展,阐述了低温双通道氧合机械灌注(D-HOPE)在离体劈离式肝移植中的应用和未来发展方向,旨在为增加离体劈离式肝移植的供肝来源,进一步改善供肝短缺的现状提供参考。Abstract: The technology of split liver transplantation is becoming increasingly mature with rapid development. During ex vivo splitting, the depletion of intracellular energy sources [such as adenosine triphosphate (ATP)] and other metabolic disorders may lead to cell damage and dysfunction, which will be aggravated by reperfusion injury of liver transplantation, clinically manifested as postoperative complications and transplantation failure. To further improve the quality of donor liver in ex vivo split liver transplantation, research teams at home and abroad apply machine perfusion to enhance the quality of donor liver. In this article, the research progresses worldwide on machine perfusion of donor liver in ex vivo split liver transplantation were reviewed, and the application and prospect of dual hypothermic oxygenated machine perfusion (D-HOPE) in ex vivo split liver transplantation were elucidated, aiming to provide reference for increasing the source of donor liver for ex vivo split liver transplantation and further resolving the current status of donorliver shortage.
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表 1 D-HOPE在离体劈离式肝移植中应用的文献报道
Table 1. Literature reports on the application of D-HOPE in ex vivo split liver transplantation
研究者 年份 供者 灌注温度 灌注方式 灌注压力① 移植肝叶 D-HOPE时间(min) SCS时间(min) 总灌注时间(min) Spada, et al[3] 2020年 19岁DBD供者 10 ℃ Belzer MPS UW②机械灌注液,1 L /min 100% 氧气氧合,达到PaO2③≥450 mmHg 6/25 S2段 300 360 660 右三叶 480 360 840 Thorne, et al[20] 2021年 52岁DBD供者 < 10 ℃ UW机械灌注液,1 L/min 100% 氧气氧合,达到PaO2 > 795 mmHg 3/25 左外叶 125 205 330 右三叶 152 468 620 注:①灌注压力为门静脉(mmHg)/肝动脉(mmHg)。
②UW为威斯康星大学。
③PaO2为动脉血氧分压。 -
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