离体机械灌注技术在肝移植供肝保存中的研究进展

Research progress of machine perfusion in donor liver preservation

肝移植是终末期肝病重要的治疗手段之一,良好的供肝保存技术对于成功开展肝移植具有重要作用。目前临床应用较为广泛的静态冷保存(SCS)技术仍面临着供肝保存时间短及缺血再灌注损伤较明显等缺点,影响肝移植预后。近年来,离体供肝机械灌注(MP)保存技术逐渐发展,其主要通过机械动力将灌注液持续泵入供肝,在提供代谢底物的同时清除代谢废物,该技术较SCS具有延长供肝保存时间以及提高供肝质量等优点,且MP对于扩大标准供者供肝的保存也表现出一定优势。但MP也存在费用较高、仪器复杂和临床研究较少等缺点,在一定程度上限制其应用。目前离体供肝MP保存相关研究是器官保存研究的前沿和热点领域,主要集中在供肝保存、评估和修复等方面。本文就近年来离体供肝MP的研究现状及其在供肝质量评估和修复中的重要作用进行综述。

Liver transplantation is one of the main treatments for end-stage liver disease,and good donor liver preservation techniques play an important role in the successful implementation of liver transplantation.At present,the static cold storage(SCS)technique,which is widely used in clinical practice,still faces the shortcomings of short preservation time and ischemia-reperfusion injury,which affects the prognosis of liver transplantation.In recent years,the machine perfusion(MP)for isolated donor liver preservation has been developed.It mainly uses mechanical power to continuously pump the perfusate into the donor liver to remove metabolic waste while providing metabolic substrates.Compared with SCS,MP has the advantages of prolonging the preservation time and improving the quality of donor organs,and MP also shows certain advantages for the preservation of donor liver from extended criteria donor.However,MP also has disadvantages such as higher cost,complicated instrument system and less clinical research,which limits its application.Studies on MP preservation of donor livers are currently at the forefront of organ preservation research,mainly focusing on the preservation,assessment,and restoration of donor liver.Here we reviewed the recent research progress of MP and its important role in the quality assessment and restoration of donor liver.