Liver graft preservation methods during cold ischemia phase and normothermic machine perfusion
Liver graft preservation methods during cold ischemia phase and normothermic machine perfusion作者机构：Department of Surgery Altai State Medical University
出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)
年 卷 期：2019年第11卷第3期
页 面：126-142页
核心收录：
主 题：Liver graft preservation Graft preservation solutions Static cold storage Hypothermic machine perfusion Normothermic machine perfusion Ischemia-reperfusion injury Marginal grafts Donation after cardiac death Extended criteria donors Transpla complications
摘 要：The growing demand for donor organs requires measures to expand donor *** include extended criteria donors, such as elderly people, steatotic livers,donation after cardiac death, etc. Static cold storage to reduce metabolic requirements developed by Collins in late 1960 s is the mainstay and the golden standard for donated organ protection. Hypothermic machine perfusion provides dynamic organ preservation at 4°C with protracted infusion of metabolic substrates to the graft during the ex vivo period. It has been used instead of static cold storage or after it as short perfusion in transplant center. Normothermic machine perfusion(NMP) delivers oxygen, and nutrition at physiological temperature mimicking regular environment in order to support cellular function. This would minimize effects of ischemia/reperfusion ***, NMP may help to estimate graft functionality before implantation into a recipient. Clinical studies demonstrated at least its non-inferiority or better outcomes vs static cold storage. Regular grafts donated after brain death could be safely preserved with convenient static cold storage. Except for prolonged ischemia time where hypothermic machine perfusion started in transplant center could be estimated to provide possible positive reconditioning effect. Use of hypothermic machine perfusion in regular donation instead of static cold storage or in extended criteria donors requires further investigation. Multicenter randomized clinical trial supposed to be completed in December 2021. Extended criteria donors need additional measures for graft storage and assessment until its implantation. NMP is actively evaluating promising method for this *** studies are necessary for precise estimation and confirmation to issue clinical practice recommendations.
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