Upper limit of normothermic machine preservation of liver grafts from donation after circulatory death yet to be defined  

作　　者：William H Archie Maria Baimas-George Nathanael Haynes Souma Kundu Katheryn Peterson Chase J Wehrle Damien Huckleberry Lon Eskind David Levi Jose R Soto Roger Denny Vincent Casingal Allyson Cochran Erin H Rein Dionisios Vrochides 

机构地区：[1]Division of Adominal Transplant,Department of Surgery,Carolinas Medical Center,Charlotte,NC 28203,United States [2]Department of Hepato-Pancreato-Biliary/Liver Transplant Surgery,Cleveland Clinic Transplant Research Center,Cleveland,OH 44195,United States [3]Department of Surgery,Carolinas Center for Surgical Outcomes Science,Carolinas Medical Center,Charlotte,NC 28203,United States

出　　处：《World Journal of Transplantation》2025年第2期218-227,共10页世界移植杂志(英文)

摘　　要：BACKGROUND The normothermic machine perfusion pump(NMPP)could shape the future of transplantation.Providing ex-vivo optimization,NMPP attenuates ischemic insult while replenishing energy.An understanding of machine perfusion time(MPT)impact and potential clinical benefits is paramount and necessitates exploration.AIM To investigate the relationship between MPT and post-transplant graft function.METHODS Retrospective review of the first 50 donation after circulatory death(DCD)grafts preserved using NMPP in a tertiary institution was performed.Essential preser-vation time points,graft parameters,recipient information,and postoperative outcomes were prospectively recorded.Early allograft dysfunction(EAD),L-Graft7 score and 90-day outcomes were collected for all grafts.The first 20 re-cipients were allocated into the early group,considered the learning curve population for the center.The subsequent 30 were allocated into the late group.Recipients were also stratified into cohorts depending on MPT,i.e.,short(<8 hours),medium(8-16 hours)and long(>16 hours).RESULTS NMPP operational parameters were not predictive of EAD,L-GrAFT7 or 90-day outcomes.The early group had significantly less MPT and cold ischemia time than the late group(553 minutes vs 850 minutes,P<0.001)and(127.5 minutes vs 154 minutes,P=0.025),respectively.MPT had no impact in either group.CONCLUSION Increased MPT of DCD liver grafts had no adverse recipient results for the times utilized in this population,indicating its upper limits,likely beyond 24 hours,are not demonstrated within this study.Future studies are necessary to determine whether longer MPT is beneficial or detrimental to graft function and,if the latter,what is the maximum safe duration.Further studies of the effect of normothermic machine perfusion pump duration on long-term outcomes are also needed.

关 键 词：Normothermic machine pump perfusion Liver transplant Donation after circulatory death Ex-vivo perfusion Ischemic cholangiopathy 

分 类 号：R657.3[医药卫生—外科学]