Machine perfusion and the prevention of ischemic type biliary lesions following liver transplant:What is the evidence?

作     者：Manuel Durán Rafael Calleja Angus Hann George Clarke Ruben Ciria Anisa Nutu Rebeca Sanabria-Mateos María Dolores Ayllón Pedro López-Cillero Hynek Mergental Javier Briceño M Thamara P R Perera 

作者机构：Department of Liver TransplantationReina Sofía University HospitalCórdoba 14004Spain The Liver UnitQueen Elizabeth Hospital BirminghamBirmingham B152THUnited Kingdom Centre for Liver and Gastrointestinal ResearchInstitute of Immunology and ImmunotherapyUniversity of BirminghamBirmingham B152THUnited Kingdom 

出 版 物：《World Journal of Gastroenterology》 (世界胃肠病学杂志（英文版）)

年 卷 期：2023年第29卷第20期

页      面：3066-3083页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：funding received in the form of the Catherine Marie Enright research scholarship from the Royal Australasian College of Surgeons to support his program of research 

主　　题：Liver transplant Ischemic type biliary lesions Hypothermic oxygenated machine perfusion Normothermic machine perfusion Abdominal normothermic regional perfusion Donation after circulatory death 

摘      要：The widespread uptake of different machine perfusion(MP)strategies for liver transplant has been driven by an effort to minimize graft *** to the cholangiocytes during the liver donation,preservation,or early posttransplant period may result in stricturing of the biliary tree and inadequate biliary *** problem continues to trouble clinicians,and may have catastrophic consequences for the graft and *** injury,as a result of compromised hepatic artery flow,is a well-known cause of biliary strictures,sepsis,and graft ***,very similar lesions can appear with a patent hepatic artery and these are known as ischemic type biliary lesions(ITBL)that are attributed to microcirculatory dysfunction rather than main hepatic arterial *** the warm and cold ischemic period duration appear to influence the onset of *** of the commonly used MP techniques deliver oxygen to the graft cells,and therefore may minimize the cholangiocyte injury and subsequently reduce the incidence of *** clinical experience and published evidence grows for these modalities,the impact they have on ITBL rates is important to *** this review,the evidence for the three commonly used MP strategies(abdominal normothermic regional perfusion[A-NRP],hypothermic oxygenated perfusion[HOPE],and normothermic machine perfusion[NMP])for ITBL prevention has been critically *** with ITBL definitions used in trials,coupled with variations in techniques of MP,make interpretation ***,the evidence suggests that both HOPE and A-NRP prevent ITBL in donated after circulatory death grafts compared to cold *** evidence for ITBL prevention in donor after brain death grafts with any MP technique is weak.