心脏死亡器官捐献供猪腹腔多器官簇体外常温机械灌注的初步研究  

Preliminary study of ex situ normothermic machine perfusion of porcine abdominal multiple organ block from donation after cardiac death

作　　者：陈传宝[1] 陈茂根[1] 郭义文 马逸豪 鞠卫强[1] 何晓顺[1] Chen Chuanbao;Chen Maogen;Guo Yiwen;Ma Yihao;Ju Weiqiang;He Xiaoshun(.Organ Transplant Center,Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology,Guangdong Provincial International Cooperation Base of Science and Technology(Organ Transplantation),the First Affiliated Hospital,Sun Yat-sen University,Guangzhou 510080,China)

机构地区：[1]中山大学附属第一医院器官移植中心广东省器官捐献与移植免疫重点实验室广东省器官移植国际合作基地,广州510080

出　　处：《中华移植杂志（电子版）》2021年第5期257-261,共5页Chinese Journal of Transplantation(Electronic Edition)

基　　金：国家自然科学基金(81401324,81770410);广东省基础和应用基础研究基金(2020A1515011557,2020A1515010903);广东省器官捐献与移植免疫重点实验室(2020B1212060026);广东省器官移植国际合作基地建设(2015B050501002)。

摘　　要：目的在心脏死亡器官捐献(DCD)模式下,探索利用屠宰场商品猪腹腔多器官簇(AMOB)进行常温机械灌注(NMP)的实验流程及体外维护条件。方法按照商业化流程整块获取商品猪AMOB,同时收集保存自体全血,AMOB获取后立即采用0~4℃的HCA液冲洗器官,并使用0~4℃的UW液冷保存,转运回实验室。实验采用自主设计的多器官NMP平台,猪全血作为主要灌注液成分。采用单通道灌注腹主动脉,肝上下腔静脉为主要的流出通道,灌注液直接回流至开放的灌注液池内,形成灌注循环。确认器官无明显问题,液体灌注结束后立即转运至NMP设备执行上机操作,灌洗复温时间约5 min。结果通过15次AMOB体外NMP的探索性研究,初步建立了自体全血收集保存、器官整块获取、器官灌注修整与保存、转运回实验室后的AMOB灌洗复温以及NMP上机操作与体外维护等一整套操作流程。通过执行以上实验流程,初步实现了猪AMOB体外NMP。热缺血时间(10.3±1.9)min(8~15 min),冷保存时间(188±35)min(130~284 min),体外NMP保存时间(229±120)min(120~520 min)。最长1例体外维护时间为520 min,其整个灌注期间肠道蠕动活跃,共产生胆汁44 mL,尿液30 mL。结论初步证实在DCD模式下,采用商品猪AMOB进行体外NMP保存的可行性。但要使各器官达到或接近生理状态以及长时间维持功能,尚有许多难题亟待突破。Objective To explore the experimental procedures and maintenance conditions of ex situ normothermic machine perfusion(NMP)for abdominal multiple organ block(AMOB)of commercial pigs from donation after cardiac death(DCD).Methods The AMOB of commercial pigs were obtained following a commercial process at the slaughterhouse,while autologous whole blood was collected and preserved.AMOB were infused with HCA solution(0-4℃)and stored with UW solution(0-4℃),and they were then transported to the laboratory.The NMP device used in this study was designed by our center and the collected autogenous whole blood was used as the main component of the machine perfusate.Because the normal anatomical structure was completely preserved,a single-channel perfusion of the abdominal aorta was used in this study.Suprahepatic inferior vena cava were the main outflow channel,and the perfused fluid was directly returned to the open blood pool to form the perfusion cycle.Confirm that there was no obvious problem with the organs,and immediately transfer the liquid perfusion to the NMP equipment for on-board operation.The time for rewarming and lavage was about 5 min.Results After 15 times NMP experiment of AMOB obtained from slaughterhouses,a set of preliminary experimental procedures were established,including the collection and preservation of whole blood,the procurement of AMOB,the perfusion,dressing and preservation of organ,and the rewarming and lavage,on-board operation,ex situ perfusion and maintenance of AMOB after returning to the laboratory.The porcine AMOB ex situ NMP was elementarily realized by executing the above experimental procedures.The mean of warm ischemia time was(10.3±1.9)min(8-15 min)and cold ischemia time was(188±35)min(130-284 min).The mean preservation time of ex situ NMP was(229±120)min(120-520 min).The maximum maintenance was 520 min at present,and intestinal peristalsis was active during the perfusion,and 44 mL bile and 30 mL urine were collected.Conclusions Preliminary confirmation of the feasibility of u

关 键 词：常温机械灌注 腹腔多器官簇 整块获取 心脏死亡器官捐献 

分 类 号：R617[医药卫生—外科学]