机械灌注在劈离式肝移植中的应用研究进展

Progress of mechanical perfusion in split liver transplantation

劈离式肝移植(split liver transplantation,SLT)是目前扩增移植肝源的重要技术手段,但劈离后的两个半肝属于边缘供肝,采用常用的静态低温保存(static cold storage,SCS)会使得冷缺血时间(cold ischemia time,CIT)增加,从而增加了相关术后并发症,这限制了SLT的进一步发展。机械灌注可以最大限度的减少边缘供肝在保存过程中的损伤,减少缺血再灌注的发生,能够与SLT形成优势互补。目前机械灌注在心脏死亡器官捐献(donation after cardiac death,DCD)、老年供肝、脂肪肝等其他类型的边缘供体肝移植中的应用已经较为成熟,近些年研究发现,机械灌注在SLT应用有更大的潜力和发展空间。因此本文将综述机械灌注在SLT中应用的研究进展和相关机制,以减少SLT在保存过程中的损伤。

Split liver transplantation is an essential means which expand the donor pool currently and the two livers ob⁃tained after splitting are marginal donor livers.The adoption of static cold storage during allocation and preservation leads to a high⁃er cold ischemia time,thus increasing the occurrence of related postoperative complications,which limits the further development of split liver transplantation.Mechanical perfusion as a complement to split liver transplantation can minimize the damage to the marginal donor liver during preservation and reduce the occurrence of ischemia reperfusion.At present,mechanical perfusion has achieved better efficacy in other types of marginal donor liver transplantation such as donation after cardiac death,elderly donor liv⁃er,fatty liver,and so on.In recent years,mechanical perfusion has also shown great potential for application in split liver trans⁃plantation,and limited clinical studies have shown outstanding therapeutic effects.Therefore,this paper will summarize the re⁃search progress and mechanisms related to the application of mechanical perfusion in split liver transplantation in order to promote the application of mechanical perfusion in split liver transplantation and reduce the damage of the organ during preservation.