Development of Clinical Criteria for Functional Assessment to Predict Primary Nonfunction of High-Risk Livers Using Normothermic Machine Perfusion

Mergental Hynek; Stephenson Barnaby T. F.; Laing Richard W.; Kirkham Amanda J.; Neil Desley A. H.; Wallace Lorraine L.; Boteon Yuri L.; Widmer Jeannette; Bhogal Ricky H.; Perera M. Thamara P. R.; Smith Amanda; Reynolds Gary M.; Yap Christina; Hubscher Stefan G.; Mirza Darius F.; Afford Simon C.

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Development of Clinical Criteria for Functional Assessment to Predict Primary Nonfunction of High-Risk Livers Using Normothermic Machine Perfusion

机译：开发功能评估的临床标准，以预测使用常温机灌注预测高风险性初级非功能

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Increased use of high-risk allografts is critical to meet the demand for liver transplantation. We aimed to identify criteria predicting viability of organs, currently declined for clinical transplantation, using functional assessment during normothermic machine perfusion (NMP). Twelve discarded human livers were subjected to NMP following static cold storage. Livers were perfused with a packed red cell-based fluid at 37 degrees C for 6 hours. Multilevel statistical models for repeated measures were employed to investigate the trend of perfusate blood gas profiles and vascular flow characteristics over time and the effect of lactate-clearing (LC) and non-lactate-clearing (non-LC) ability of the livers. The relationship of lactate clearance capability with bile production and histological and molecular findings were also examined. After 2 hours of perfusion, median lactate concentrations were 3.0 and 14.6 mmol/L in the LC and non-LC groups, respectively. LC livers produced more bile and maintained a stable perfusate pH and vascular flow >150 and 500 mL/minute through the hepatic artery and portal vein, respectively. Histology revealed discrepancies between subjectively discarded livers compared with objective findings. There were minimal morphological changes in the LC group, whereas non-LC livers often showed hepatocellular injury and reduced glycogen deposition. Adenosine triphosphate levels in the LC group increased compared with the non-LC livers. We propose composite viability criteria consisting of lactate clearance, pH maintenance, bile production, vascular flow patterns, and liver macroscopic appearance. These have been tested successfully in clinical transplantation. In conclusion, NMP allows an objective assessment of liver function that may reduce the risk and permit use of currently unused high-risk livers.

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《Liver transplantation: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society》 |2018年第10期|共17页
作者
Mergental Hynek; Stephenson Barnaby T. F.; Laing Richard W.; Kirkham Amanda J.; Neil Desley A. H.; Wallace Lorraine L.; Boteon Yuri L.; Widmer Jeannette; Bhogal Ricky H.; Perera M. Thamara P. R.; Smith Amanda; Reynolds Gary M.; Yap Christina; Hubscher Stefan G.; Mirza Darius F.; Afford Simon C.;
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Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Birmingham Inst Canc &

Genom Sci Canc Res UK Clin Trials Unit Birmingham W Midlands England;

Univ Hosp Birmingham Natl Hlth Serv Fdn Trust Queen Elizabeth Hosp Birmingham Liver Unit Birmingham B15 2TH W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Hosp Birmingham Natl Hlth Serv Fdn Trust Queen Elizabeth Hosp Birmingham Liver Unit Birmingham B15 2TH W Midlands England;

Univ Hosp Birmingham Natl Hlth Serv Fdn Trust Queen Elizabeth Hosp Birmingham Liver Unit Birmingham B15 2TH W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Birmingham Inst Canc &

Genom Sci Canc Res UK Clin Trials Unit Birmingham W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

Univ Birmingham Coll Med &

Dent Sci Liver Biomed Res Ctr Natl Inst Hlth Res Birmingham Birmingham W Midlands England;

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原文格式 PDF
正文语种 eng
中图分类肝及肝管;腹部外科学;
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3. A Short Period of Normothermic Machine Perfusion May Not Be Able to Predict Primary Nonfunction in Uncontrolled Circulatory Death Kidneys [J] . Hosgood Sarah A., Nicholson Michael L. Transplantation: Official Journal of the Transplantation Society . 2021,第1期

机译：短期的常温机灌注可能无法预测不受控制的循环死亡肾脏中的主要非功能
4. Transplantation of High-risk Donor Livers After Ex Situ Resuscitation and Assessment Using Combined Hypo- and Normothermic Machine Perfusion A Prospective Clinical Trial [J] . Otto B. van Leeuwen, Yvonne de Vries, Masato Fujiyoshi, Annals of Surgery . 2019,第5期

机译：采用混合和常温机械灌注，采用勘察和评估高风险供体肝脏移植术治疗前瞻性临床试验
5. Viability Criteria for Functional Assessment of Donor Livers During Normothermic Machine Perfusion [J] . van Leeuwen Otto B., de Meijer Vincent E., Porte Robert J. Liver transplantation: official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society . 2018,第10期

机译：常温机灌注期间供体肝功能评估的可行性标准
6. Successful Ex Vivo Normothermic Liver Perfusion with Purely Artificial Products Using Artificial Blood [C] . Tadashi Katsuramaki, Akihiro Nui, Hitoshi Kikuchi, Keio International Symposia for Life Sciences and Medicine . 2005

机译：使用人造血液成功与纯粹的人造产品成功的前体内常温肝灌注
7. Normothermic ex-situ Liver Perfusion and PPAR-γ Activation as Strategies to Reduce Liver Ischemia Reperfusion Injury [D] . Linares Cervantes, Iván de Jesús. 2019

机译：常温前肝灌注和PPAR-γ活化作为降低肝脏缺血再灌注损伤的策略
8. Development of Clinical Criteria for Functional Assessment to Predict Primary Nonfunction of High‐Risk Livers Using Normothermic Machine Perfusion [O] . Hynek Mergental, Barnaby T. F. Stephenson, Richard W. Laing, -1

机译：制定使用正常体温灌注机预测高危肝原发性功能的功能评估临床标准
9. Development of Clinical Criteria for Functional Assessment to Predict Primary Nonfunction of High‐Risk Livers Using Normothermic Machine Perfusion [O] . Hynek Mergental, Barnaby T. F. Stephenson, Richard W. Laing, 2018

机译：使用常温机灌注预测高风险性初级无功能的临床标准的开发
10. Health Technology Assessment Reports, 1983. Number 7. Plasma Perfusion of Charcoal Filters for Treatment of Pruritis of Cholestatic Liver Disease [R] . Cotter, D. 1983

机译：卫生技术评估报告，1983年。第7号。血浆灌注炭过滤器治疗胆汁淤积性肝病的瘙痒症

Development of Clinical Criteria for Functional Assessment to Predict Primary Nonfunction of High-Risk Livers Using Normothermic Machine Perfusion

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