肝移植物缺血-再灌注损伤的防治策略与未来展望

Strategies and future prospects for the prevention and treatment of ischemia-reperfusion injury in liver graft

  • 摘要: 供肝在获取、保存及移植过程中不可避免地会出现缺血-再灌注损伤(IRI),直接影响到肝移植的结果,是导致移植肝术后早期移植物功能障碍以及急、慢性移植物排斥反应的主要原因,也是影响边缘供肝使用而加重供体短缺的主要危险因素。随着生物医学技术的快速发展,在供肝预处理、保存与灌注技术和药物治疗等方面不断改进,尤其在机械灌注技术、无缺血肝移植技术、抗氧化、抗凋亡及抗炎治疗等方面取得了显著进展与突破,显著减轻或避免了供肝IRI,显著延长了供肝在体外的保存时间,减少了肝移植术后一系列严重并发症,同时也显著提高了边缘供肝的利用率。本文讨论了与肝脏IRI相关的机制和肝脏保存方法等进展,并探讨了有效器官保存和优化的现存问题、前沿探索和未来挑战。

     

    Abstract: Ischemia-reperfusion injury (IRI) of the donor liver is inevitable during procurement, preservation and transplantation, directly affecting the outcome of liver transplantation. It is the main cause of early allograft dysfunction and acute/chronic graft rejection after liver transplantation. It is also the main risk factor that affects the use of marginal grafts and exacerbates donor shortage. With the rapid development of biomedical technology, continuous improvements have been made in donor liver preconditioning, preservation perfusion techniques, and pharmacological treatments. Particularly significant progress and breakthroughs have been achieved in the areas of machine perfusion technology, ischaemia-free liver transplantation, anti-oxidation, anti-apoptosis and anti-inflammatory treatments. These advances have significantly reduced or prevented IRI in donor livers, extended the preservation time of donor livers ex vivo, reduced a series of severe complications after liver transplantation, and also significantly increased the utilization rate of marginal donor livers. This article discusses the progress in mechanisms related to liver IRI and liver preservation methods, and explores existing issues, cutting-edge explorations, and future challenges in effective organ preservation and optimization.

     

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