常温局部灌注支持下DCD供者劈离式肝移植的临床实践与前景展望

Clinical practice and prospect of split liver transplantation with DCD donors under normothermic regional perfusion support

  • 摘要: 全球器官短缺使心脏死亡器官捐献(DCD)成为肝移植的重要供者来源,但其应用受限于热缺血损伤及原位劈离的技术难题,目前尚缺乏安全的DCD劈离式肝移植策略。常温局部灌注(NRP)技术通过在循环死亡后快速重建腹腔氧合血供,有效减轻热缺血损伤,为DCD供肝的原位劈离创造了稳定的操作条件。目前,NRP支持下的供肝劈离在供肝动态评估、代谢恢复监测及劈离决策支持等方面已取得一定进展。因此,本文就NRP支持下DCD原位劈离式肝移植的技术适配性与初步临床实践结果进行评述,并分析推广中的主要障碍,探讨未来研究方向,以期为劈离式肝移植进一步临床应用提供参考。

     

    Abstract: Due to the global shortage of organs, donation after circulatory death (DCD) has become an important source of liver grafts for liver transplantation. Nevertheless, its application is limited by warm ischemic injury and technical challenges associated with in-situ splitting, and safe protocols for split liver transplantation with DCD grafts remain lacking at present. Normothermic regional perfusion (NRP) rapidly re-establishes oxygenated abdominal blood supply after circulatory arrest, effectively alleviating warm ischemic injury and creating stable operative conditions for in-situ splitting of DCD liver grafts. To date, liver splitting performed under NRP has achieved certain advances in dynamic graft assessment, monitoring of metabolic recovery, and decision-making for graft splitting. Accordingly, this article reviews the technical adaptability and preliminary clinical outcomes of in-situ split liver transplantation with DCD grafts assisted by NRP, analyses the major obstacles to its popularization, and explores future research directions, so as to provide references for further clinical application of split liver transplantation.

     

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