切换至 "中华医学电子期刊资源库"

中华移植杂志(电子版) ›› 2024, Vol. 18 ›› Issue (06) : 334 -345. doi: 10.3877/cma.j.issn.1674-3903.2024.06.002

标准与指南

肝脏体外机械灌注临床应用指南
中华医学会器官移植学分会   
  • 收稿日期:2024-12-13 出版日期:2024-12-25
  • 基金资助:
    国家自然科学基金面上项目(81970564,82070670,82170663,82370664,82300744)

Guideline on the clinical application of ex situ liver machine perfusion

of Organ Transplantation of Chinese Medical Association Branch   

  • Received:2024-12-13 Published:2024-12-25
引用本文:

中华医学会器官移植学分会. 肝脏体外机械灌注临床应用指南[J/OL]. 中华移植杂志(电子版), 2024, 18(06): 334-345.

of Organ Transplantation of Chinese Medical Association Branch. Guideline on the clinical application of ex situ liver machine perfusion[J/OL]. Chinese Journal of Transplantation(Electronic Edition), 2024, 18(06): 334-345.

器官移植已成为各类终末器官功能衰竭的标准治疗方法。 然而,世界各国均面临严峻的器官短缺形势,迫使临床医师更多地使用扩大标准供者器官。 常规的静态冷保存技术无法满足该类器官功能评估与减轻缺血损伤的要求,因此,各类体外机械灌注技术应运而生。 肝脏体外机械灌注技术主要包括低温机械灌注、低温有氧机械灌注、常温机械灌注、无缺血肝移植和亚常温机械灌注等技术。 近年来国内外开展的研究结果表明,体外机械灌注技术具有延长供肝保存时间、评估供肝质量、减轻缺血再灌注损伤和改善移植预后等优势。 为加快肝脏体外机械灌注技术在我国的临床应用,本指南结合国内外研究结果,基于循证医学原则,从供肝获取、保存、质量评估和临床预后方面形成肝脏体外机械灌注的推荐意见。

Organ transplantation is the standard treatment for end-stage organ failure, yet severe shortages of organs persist worldwide, necessitating the use of organs from extended criteria donor.Traditional static cold storage has limitations in evaluating organ function and mitigating ischemia-reperfusion injury.Consequently, various ex situ machine perfusion techniques have been developed, including hypothermic machine perfusion, hypothermic oxygenated perfusion, normothermic machine perfusion, ischemia-free liver transplantation, and sub-normothermic machine perfusion.Recent studies demonstrate that these technologies can extend preservation time, enable liver quality assessment, reduce ischemia-reperfusion injury, and improve transplantation prognosis.This guideline aims to promote the clinical application of ex situ liver machine perfusion in China.Based on evidencebased medicine principles and recent studies, recommendations are provided on graft procurement,preservation, quality evaluation, and transplantation prognosis.

表1 推荐意见分级的评估、制订与评价系统
表2 肝脏体外机械灌注推荐意见汇总
序号 推荐意见 证据级别 推荐强度
HMP
1 无氧供HMP/ HMP-O2 的灌注液温度推荐控制在4 ~8 ℃
2 无氧供HMP/ HMP-O2 的灌注流速推荐为0. 66 mL·min -1 ·g -1 (肝脏)
3 HMP-O2 灌注前,推荐以10 L/ min 的速度预充纯氧至少20 min
4 HOPE/ DHOPE 的灌注液温度推荐控制在8 ~10 ℃
5 HOPE/ DHOPE 的门静脉灌注压力推荐为2 ~5 mmHg,灌注流速推荐为100 ~ 400 mL/ min;肝动脉的灌注压力推荐为20 ~30 mmHg,灌注流速推荐为50 ~ 150 mL/ min;灌注液氧分压推荐为60 ~ 100 kPa,氧流速推荐为500 ~1 000 mL/ min
6 FMN 对HOPE 评估供肝质量具有潜在价值
7 DHOPE-COR-NMP 序贯机械灌注有利于评估高风险供肝
8 无氧供HMP 有助于降低DNDD 供肝术后早期移植物功能不全发生率,增加边缘性供肝使用率
9 HMP-O2 有助于降低术后早期移植物功能不全发生率
10 HMP-O2 有助于降低术后胆道并发症发生率
11 HOPE/ DHOPE 能提高肝移植术后1 年移植物生存率
12 HOPE/ DHOPE 能降低术后严重并发症(Clavien-Dindo 分级≥Ⅲb)发生率,且能降低ECD-DNDD 供肝术后胆道非吻合口狭窄发生率
13 HOPE/ DHOPE 能降低术后早期移植物功能不全发生率,且能降低DCDD 供肝术后胆道非吻合口狭窄发生率
14 HOPE/ DHOPE 能提高ECD-DNDD 供肝术后5 年移植物生存率
15 HOPE/ DHOPE 能降低术后再移植率
16 HOPE/ DHOPE 能降低DCDD 供肝术后急性排斥反应发生率
17 供肝体外劈离可在HOPE 的支持下进行,有助于减轻劈离肝缺血损伤
NMP
18 NMP 的灌注液温度推荐控制在34 ~37 ℃;肝动脉的灌注流速推荐为150 ~400 mL/ min,灌注压力推荐为45 ~75 mmHg;门静脉的灌注流速推荐为700 ~1 700 mL/ min,灌注压力推荐为4 ~10 mmHg
19 NMP 的灌注液推荐采用胶体溶液替代血浆,采用洗涤红细胞或者人造血红蛋白作为携氧载体,在此基础上加入抗生素、肝素、碳酸氢钠缓冲液和静脉营养剂等成分
20 采用COR 衔接DHOPE 和NMP 时,推荐采用人造血红蛋白作为灌注液的携氧载体,亦可采用洗涤红细胞,并加入抗生素、肝素等NMP 所需的灌注液成分
21 DHOPE-COR-NMP 的复温阶段,推荐以每2 min 提升1 ℃的速度逐渐提高灌注液的温度,同时逐渐增加门静脉和肝动脉的灌注压力至NMP 的合适范围内
22 灌注液中的肝脏代谢相关指标对NMP 下评估供肝质量有重要价值,推荐采用灌注液乳酸水平、pH 值、葡萄糖、胆汁生成、胆汁pH 值以及肝动脉和门静脉流速等指标评估肝脏质量
23 NMP 能减轻移植物早期损伤
24 NMP 有助于降低术后严重并发症(Clavien-Dindo 分级≥Ⅲb)发生率,并降低缺血性胆道病变发生率
25 NMP 能降低DCDD 供肝术后早期移植物功能不全发生率,增加边缘性供肝使用率
26 NMP 能降低复流后综合征发生率
IFLT
27 IFLT 能够减轻供肝IRI,降低DNDD 供肝移植术后早期移植物功能不全发生率
28 IFLT 能降低DNDD 供肝移植术后综合并发症评分,减少移植术中复流后综合征和术后胆道非吻合口狭窄发生率
29 IFLT 能降低DNDD 供肝移植术后肝细胞癌复发率
30 IFLT 技术能减少肝移植术后ICU 住院时间
31 IFLT 有助于提高边缘性供肝使用率
32 IFLT 技术能有效减少灌注液病原微生物污染
临床试验开展
33 开展NMP 灌注边缘性供肝的RCT 和体外药物干预的临床试验 / /
34 开展序贯机械灌注的临床RCT / /
35 建立统一的机械灌注下供肝质量评估标准 / /
1
Trotter JF.Liver transplantation around the world[J].Curr Opin Organ Transplant,2017,22(2):123-127.
2
Tector AJ, Mangus RS, Chestovich P, et al.Use of extended criteria livers decreases wait time for liver transplantation without adversely impacting posttransplant survival[J].Ann Surg, 2006, 244(3):439-450.
3
中国医师协会器官移植医师分会, 中华医学会器官移植学分会,中华医学会外科学分会移植学组, 中国医院协会器官获取与分配工作委员会.中国心脏死亡捐献器官评估与应用专家共识(2022 版)[J/CD].中华移植杂志:电子版, 2022, 16(6): 321-328.
4
Pandya K, Sastry V, Panlilio MT, et al.Differential impact of extended criteria donors after brain death or circulatory death in adult liver transplantation[J].Liver Transpl,2020,26(12):1603-1617.
5
Parente A, Sun K, Dutkowski P, et al.Routine utilization of machine perfusion in liver transplantation:ready for prime time?[J].World J Gastroenterol,2024,30(11):1488-1493.
6
Kim SC, Foley DP.Strategies to improve the utilization and function of DCD livers[J].Transplantation,2024,108(3):625-633.
7
王彦峰, 王云昊.肝脏机械灌注研究进展[J].中华器官移植杂志,2023,44(8):449-453.
8
de Meijer VE, Fujiyoshi M, Porte RJ. Ex situ machine perfusion strategies in liver transplantation[J].J Hepatol,2019,70(1):203-205.
9
Schlegel A, Mergental H, Fondevila C, et al.Machine perfusion of the liver and bioengineering[J].J Hepatol, 2023, 78(6): 1181-1198.
10
汪恺, 苏仁义, 王周城, 徐骁.“机械灌注+”视阈下扩大标准供肝的修复与功能提升[J].中华消化外科杂志, 2022,21(1):74-78.
11
Ceresa CDL, Nasralla D, Pollok JM, et al.Machine perfusion of the liver: applications in transplantation and beyond [J].Nat Rev Gastroenterol Hepatol,2022,19(3):199-209.
12
Guo Z, Zhao Q, Jia Z, et al.A randomized-controlled trial of ischemia-free liver transplantation for end-stage liver disease[J].J Hepatol,2023,79(2):394-402.
13
Huang C, Huang S, Tang Y, et al.Prospective, single-centre,randomised controlled trial to evaluate the efficacy and safety of ischaemia-free liver transplantation (IFLT) in the treatment of endstage liver disease[J].BMJ Open,2020,10(5): e035374.
14
Balshem H, Helfand M,Schünemann HJ,et al.GRADE guidelines:3.Rating the quality of evidence[J].J Clin Epidemiol, 2011, 64(4):401-406.
15
Karangwa S, Panayotova G, Dutkowski P, et al.Hypothermic machine perfusion in liver transplantation[J].Int J Surg, 2020,82S:44-51.
16
Guarrera JV, Henry SD, Samstein B, et al.Hypothermic machine preservation in human liver transplantation: the first clinical series[J].Am J Transplant,2010,10(2):372-381.
17
Panayotova GG, Lunsford KE, Quillin RC 3rd, et al.Portable hypothermic oxygenated machine perfusion for organ preservation in liver transplantation: a randomized, open-label, clinical trial[J].Hepatology,2024,79(5):1033-1047.
18
van Rijn R, Schurink IJ, de Vries Y, et al.Hypothermic machine perfusion in liver transplantation-a randomized trial[J].N Engl J Med,2021,384(15):1391-1401.
19
Schlegel A, Mueller M, Muller X, et al.A multicenter randomizedcontrolled trial of hypothermic oxygenated perfusion (HOPE) for human liver grafts before transplantation[J].J Hepatol, 2023, 78(4):783-793.
20
Ravaioli M, Germinario G, Dajti G, et al.Hypothermic oxygenated perfusion in extended criteria donor liver transplantation-a randomized clinical trial[J].Am J Transplant,2022,22(10):2401-2408.
21
Czigany Z, Pratschke J, Froněk J, et al.Hypothermic oxygenated machine perfusion reduces early allograft injury and improves posttransplant outcomes in extended criteria donation liver transplantation from donation after brain death:results from a multicenter randomized controlled trial (HOPE ECD-DBD)[J].Ann Surg,2021,274(5):705-712.
22
Grᶏt M, Morawski M, Zhylko A, et al.Routine end-ischemic hypothermic oxygenated machine perfusion in liver transplantation from donors after brain death: a randomized controlled trial[J].Ann Surg,2023,278(5):662-668.
23
Brüggenwirth IMA, Lantinga VA, Rayar M, et al.Prolonged dual hypothermic oxygenated machine preservation (DHOPE-PRO) in liver transplantation: study protocol for a stage 2, prospective, dualarm, safety and feasibility clinical trial[J].BMJ Open Gastroenterol,2022,9(1): e000842.
24
Ramos P, Williams P,Salinas J,et al.Abdominal organ preservation solutions in the age of machine perfusion[J].Transplantation,2023,107(2):326-340.
25
Dutkowski P, Polak WG, Muiesan P, et al.First comparison of hypothermic oxygenated perfusion versus static cold storage of human donation after cardiac death liver transplants: an internationalmatched case analysis[J].Ann Surg, 2015, 262(5): 764-770;discussion 770-771.
26
Brüggenwirth IMA, Lantinga VA, Lascaris B, et al.Prolonged hypothermic machine perfusion enables daytime liver transplantationan IDEAL stage 2 prospective clinical trial[J].EClinicalMedicine,2024,68:102411.
27
Sousa Da Silva RX, Weber A, Dutkowski P, et al.Machine perfusion in liver transplantation[J].Hepatology, 2022, 76(5):1531-1549.
28
van Leeuwen OB, Bodewes SB, Lantinga VA, et al.Sequential hypothermic and normothermic machine perfusion enables safe transplantation of high-risk donor livers[J].Am J Transplant,2022,22(6):1658-1670.
29
de Vries Y, Berendsen TA, Fujiyoshi M, et al.Transplantation of high-risk donor livers after resuscitation and viability assessment using a combined protocol of oxygenated hypothermic, rewarming and normothermic machine perfusion: study protocol for a prospective,single-arm study (DHOPE-COR-NMP trial)[J].BMJ Open,2019,9(8): e028596.
30
Patrono D, Catalano G, Rizza G, et al.Perfusate analysis during dual hypothermic oxygenated machine perfusion of liver grafts:correlations with donor factors and early outcomes [ J ].Transplantation,2020,104(9):1929-1942.
31
Schlegel A, Muller X, Mueller M, et al.Hypothermic oxygenated perfusion protects from mitochondrial injury before liver transplantation[J].EBioMedicine,2020,60:103014.
32
Muller X, Schlegel A, Kron P, et al.Novel real-time prediction of liver graft function during hypothermic oxygenated machine perfusion before liver transplantation[J].Ann Surg, 2019, 270(5): 783-790.
33
Eden J, Thorne AM, Bodewes SB, et al.Assessment of liver graft quality during hypothermic oxygenated perfusion: the first international validation study[J].J Hepatol, 2024: S0168-8278(24)02543-1.
34
Minor T, von Horn C, Zlatev H, et al.Controlled oxygenated rewarming as novel end-ischemic therapy for cold stored liver grafts.A randomized controlled trial[J].Clin Transl Sci, 2022, 15(12):2918-2927.
35
van Leeuwen OB, de Vries Y, Fujiyoshi M, et al.Transplantation of high-risk donor livers after ex situ resuscitation and assessment using combined hypo-and normothermic machine perfusion: a prospective clinical trial[J].Ann Surg,2019,270(5):906-914.
36
van Leeuwen OB, Bodewes SB, Porte RJ, et al.Excellent long-term outcomes after sequential hypothermic and normothermic machine perfusion challenges the importance of functional donor warm ischemia time in DCD liver transplantation[J].J Hepatol, 2023, 79(6):e244-e245.
37
Guarrera JV, Henry SD, Samstein B, et al.Hypothermic machine preservation facilitates successful transplantation of “ orphan ”extended criteria donor livers[J].Am J Transplant, 2015, 15(1):161-169.
38
Eden J, Brüggenwirth IMA, Berlakovich G, et al.Long-term outcomes after hypothermic oxygenated machine perfusion and transplantation of 1 202 donor livers in a real-world setting (HOPEREAL study)[J].J Hepatol,2025,82(1):97-106.
39
Tang G, Zhang L, Zhou R.Comment on “Machine perfusion techniques for liver transplantation-a meta-analysis of the first seven randomized-controlled trials”[J].J Hepatol, 2024, 80(3): e114-e115.
40
Tang G, Zhang L,Xia L,et al.Hypothermic oxygenated perfusion in liver transplantation: a meta-analysis of randomized controlled trials and matched studies[J].Int J Surg,2024,110(1):464-477.
41
Tang G, Zhang L, Zhou R.A commentary on “Effects of machine perfusion strategies on different donor types in liver transplantation: a systematic review and meta-analysis”[J].Int J Surg, 2023, 109(12):4377-4379.
42
Liang A, Cheng W, Cao P, et al.Effects of machine perfusion strategies on different donor types in liver transplantation:a systematic review and meta-analysis[J].Int J Surg, 2023, 109(11): 3617-3630.
43
Tingle SJ, Dobbins JJ, Thompson ER, et al.Machine perfusion in liver transplantation[J].Cochrane Database Syst Rev,2023,9(9):CD014685.
44
Parente A, Tirotta F,Pini A,et al.Machine perfusion techniques for liver transplantation-a meta-analysis of the first seven randomizedcontrolled trials[J].J Hepatol,2023,79(5):1201-1213.
45
Czigany Z, Uluk D, Pavicevic S, et al.Improved outcomes after hypothermic oxygenated machine perfusion in liver transplantationlong-term follow-up of a multicenter randomized controlled trial[J].Hepatol Commun,2024,8(2): e0376.
46
Olthoff KM, Kulik L, Samstein B, et al.Validation of a current definition of early allograft dysfunction in liver transplant recipients and analysis of risk factors[J].Liver Transpl, 2010, 16(8):943-949.
47
Liang A, Cheng W, Cao P, et al.Effects of machine perfusion strategies on different donor types in liver transplantation:a systematic review and meta-analysis[J].Int J Surg, 2023, 109(11): 3617-3630.
48
Maspero M, Ali K, Cazzaniga B, et al.Acute rejection after liver transplantation with machine perfusion versus static cold storage: a systematic review and meta-analysis[J].Hepatology,2023,78(3):835-846.
49
Liang A, Zhang L, Jia J, et al.The conclusion of reducing acute rejection after liver transplantation by machine perfusion should be extrapolated with caution[J].Hepatobiliary Surg Nutr, 2023, 12(5):785-789.
50
Rossignol G, Muller X, Ruiz M, et al.HOPE mitigates ischemiareperfusion injury in ex-situ split grafts: a comparative study with living donation in pediatric liver transplantation[J].Transpl Int,2024,37:12686.
51
Rossignol G, Muller X, Hervieu V, et al.Liver transplantation of partial grafts after ex situ splitting during hypothermic oxygenated perfusion-The HOPE-Split pilot study[J].Liver Transpl, 2022, 28(10):1576-1587.
52
Mabrut JY, Lesurtel M, Muller X, et al. Ex vivo liver splitting and hypothermic oxygenated machine perfusion: technical refinements of a promising preservation strategy in split liver transplantation [J].Transplantation,2021,105(8): e89-e90.
53
Marecki H, Bozorgzadeh A, Porte RJ, et al.Liver ex situ machine perfusion preservation: a review of the methodology and results of large animal studies and clinical trials[J].Liver Transpl, 2017, 23(5):679-695.
54
Quintini C, Martins PN, Shah S, et al.Implementing an innovated preservation technology:the American Society of Transplant Surgeons′(ASTS) Standards Committee White Paper on ex situ liver machine perfusion[J].Am J Transplant,2018,18(8):1865-1874.
55
Martins PN, Buchwald JE, Mergental H, et al.The role of normothermic machine perfusion in liver transplantation[J].Int J Surg,2020,82S:52-60.
56
Nasralla D, Coussios CC, Mergental H, et al.A randomized trial of normothermic preservation in liver transplantation[J].Nature,2018,557(7703):50-56.
57
Krendl FJ, Cardini B, Laimer G, et al.Normothermic liver machine perfusion and successful transplantation of split liver grafts:from proof of concept to clinical implementation[J].Transplantation, 2024,108(6):1410-1416.
58
Clavien PA, Dutkowski P, Mueller M, et al.Transplantation of a human liver following 3 days of ex situ normothermic preservation[J].Nat Biotechnol,2022,40(11):1610-1616.
59
Kathirvel M, Nasralla D, Iype S, et al.Salvage of a right-extended split liver graft using ex situ normothermic machine perfusion-a new therapeutic horizon[J].Transplantation, 2022, 106(6): e320-e321.
60
Melandro F, De Carlis R, Torri F, et al.Viability criteria during liver ex-situ normothermic and hypothermic perfusion[J].Medicina(Kaunas),2022,58(10):1434.
61
Markmann JF, Abouljoud MS, Ghobrial RM, et al.Impact of portable normothermic blood-based machine perfusion on outcomes of liver transplant: the OCS liver PROTECT randomized clinical trial[J].JAMA Surg,2022,157(3):189-198.
62
Guo Z, Zhao Q, Jia Z, et al.A randomized-controlled trial of ischemia-free liver transplantation for end-stage liver disease[J].J Hepatol,2023,79(2):394-402.
63
Mergental H, Laing RW, Kirkham AJ, et al.Transplantation of discarded livers following viability testing with normothermic machine perfusion[J].Nat Commun,2020,11(1):2939.
64
Mergental H, Laing RW, Kirkham AJ, et al.Discarded livers tested by normothermic machine perfusion in the VITTAL trial: secondary end points and 5-year outcomes[J].Liver Transpl, 2024, 30(1):30-45.
65
Laing RW, Mergental H, Yap C, et al.Viability testing and transplantation of marginal livers (VITTAL) using normothermic machine perfusion: study protocol for an open-label, nonrandomised, prospective, single-arm trial[J].BMJ Open, 2017, 7(11): e017733.
66
Brüggenwirth IMA, de Meijer VE, Porte RJ, et al.Viability criteria assessment during liver machine perfusion [J].Nat Biotechnol,2020,38(11):1260-1262.
67
Banan B, Watson R, Xu M, et al.Development of a normothermic extracorporeal liver perfusion system toward improving viability and function of human extended criteria donor livers[J].Liver Transpl,2016,22(7):979-993.
68
Boteon YL, Attard J, Boteon APCS, et al.Manipulation of lipid metabolism during normothermic machine perfusion:effect of defatting therapies on donor liver functional recovery[J].Liver Transpl,2019,25(7):1007-1022.
69
Abbas SH, Ceresa CDL, Hodson L, et al.Defatting of donor transplant livers during normothermic perfusion-a randomised clinical trial: study protocol for the DeFat study[J].Trials, 2024, 25(1):386.
70
Hefler J, Leon-Izquierdo D, Marfil-Garza BA, et al.Long-term outcomes after normothermic machine perfusion in liver transplantation-experience at a single North American center[J].Am J Transplant,2023,23(7):976-986.
71
Robinson T, Vargas PA, Yemini R, et al.Are we on track to increase organ utilization? An analysis of machine perfusion preservation for liver transplantation in the United States[J].Artif Organs,2024,48(11):1275-1287.
72
MacConmara M, Hanish SI, Hwang CS, et al.Making every liver count: increased transplant yield of donor livers through normothermic machine perfusion[J].Ann Surg,2020,272(3):397-401.
73
Ghinolfi D, Rreka E, De Tata V, et al.Pilot, open, randomized,prospective trial for normothermic machine perfusion evaluation in liver transplantation from older donors[J].Liver Transpl, 2019, 25(3):436-449.
74
Quintini C, Del Prete L, Simioni A, et al.Transplantation of declined livers after normothermic perfusion[J].Surgery,2022,171(3):747-756.
75
Guo Z, Luo T, Mo R, et al.Ischemia-free organ transplantation-a review[J].Curr Opin Organ Transplant,2022,27(4):300-304.
76
Huang C, Huang S, Tang Y, et al.Prospective, single-centre,randomised controlled trial to evaluate the efficacy and safety of ischaemia-free liver transplantation (IFLT) in the treatment of endstage liver disease[J].BMJ Open,2020,10(5): e035374.
77
Guo Z, Zhao Q, Huang S, et al.Ischaemia-free liver transplantation in humans: a first-in-human trial[J].Lancet Reg Health West Pac,2021,16:100260.
78
Zhang Z, Tang Y, Zhao Q, et al.Association of perfusion characteristics and posttransplant liver function in ischemia-free liver transplantation[J].Liver Transpl,2020,26(11):1441-1454.
79
Tang Y, Wang T, Ju W, et al.Ischemic-free liver transplantation reduces the recurrence of hepatocellular carcinoma after liver transplantation[J].Front Oncol,2021,11:773535.
80
Lin J, Li Y, Fang T, Wang T, et al.Substantial decline of organ preservation fluid contamination following adoption of ischemia-free liver transplantation: a post-hoc analysis[J].Int J Surg,2024,110(5):2855-2864.
81
Chen M, Chen Z, Lin X, et al.Application of ischaemia-free liver transplantation improves prognosis of patients with steatotic donor livers-a retrospective study[J].Transpl Int, 2021, 34(7): 1261-1270.
82
Banker A, Bhatt N, Rao PS, et al.A review of machine perfusion strategies in liver transplantation[J].J Clin Exp Hepatol, 2023, 13(2):335-349.
83
Karimian N, Raigani S, Huang V, et al.Subnormothermic machine perfusion of steatotic livers results in increased energy charge at the cost of anti-oxidant capacity compared to normothermic perfusion[J].Metabolites,2019,9(11):246.
84
Ciria R, Ayllon-Teran MD, González-Rubio S, et al.Rescue of discarded grafts for liver transplantation by ex vivo subnormothermic and normothermic oxygenated machine perfusion: first experience in Spain[J].Transplant Proc,2019,51(1):20-24.
85
Martins PN, Rizzari MD, Ghinolfi D, et al.Design, analysis, and pitfalls of clinical trials using ex situ liver machine perfusion: the international liver transplantation society consensus guidelines[J].Transplantation,2021,105(4):796-815.
86
于欣雨, 郭志勇.2020 国际肝移植协会(ILTS)肝脏机械灌注共识——专家解读[J/CD].实用器官移植电子杂志, 2022, 10(3):201-206.
87
Karangwa SA, Dutkowski P, Fontes P, et al.Machine perfusion of donor livers for transplantation: a proposal for standardized nomenclature and reporting guidelines[J].Am J Transplant, 2016,16(10):2932-2942.
88
op den Dries S, Westerkamp AC, Karimian N, et al.Injury to peribiliary glands and vascular plexus before liver transplantation predicts formation of non-anastomotic biliary strictures [ J].J Hepatol,2014,60(6):1172-1179.
89
Ghinolfi D, Pezzati D,Rreka E, et al.Transient cold storage prior to normothermic liver perfusion may facilitate adoption of a novel technology[J].Liver Transpl,2019,25(10):1503-1513.
90
Mathis S, Weissenbacher A, Putzer G, et al.Interleukin-6 levels during normothermic machine perfusion impact postreperfusion hemodynamics of liver graft recipients: a prospective single-center observational study[J].Transplantation, 2024, 108(5): 1166-1171.
91
Cox DRA, Lee E, Wong BKL, McClure T, et al.Graft-derived cfDNA monitoring in plasma and bile during normothermic machine perfusion in liver transplantation is feasible and a potential tool for assessing graft viability[J].Transplantation, 2024, 108(4): 958-962.
92
Meszaros AT, Hofmann J, Buch ML, et al.Mitochondrial respiration during normothermic liver machine perfusion predicts clinical outcome[J].EBioMedicine,2022,85:104311.
93
Liu J, Martins PN, Bhat M, et al.Biomarkers and predictive models of early allograft dysfunction in liver transplantation-a systematic review of the literature, meta-analysis, and expert panel recommendations[J].Clin Transplant,2022,36(10): e14635.
94
Dingfelder J, Rauter L, Berlakovich GA, et al.Biliary viability assessment and treatment options of biliary injury during normothermic liver perfusion-a systematic review[J].Transpl Int, 2022, 35:10398.
[1] 陈进宏. 腹腔镜活体供肝获取规范与创新[J/OL]. 中华普通外科学文献(电子版), 2024, 18(05): 324-324.
[2] 唐亦骁, 陈峻, 连正星, 胡海涛, 鲁迪, 徐骁, 卫强. 白果内酯对小鼠肝缺血再灌注损伤保护作用研究[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 278-282.
[3] 胡宁宁, 赵延荣, 王栋, 王胜亮, 郭源. FMNL3与肝细胞癌肝移植受者预后的相关性研究[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 283-288.
[4] 仲福顺, 余露, 范晓礼, 叶啟发. 肝移植治疗肝上皮样血管内皮瘤一例[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 293-297.
[5] 刘冉佳, 崔向丽, 周效竹, 曲伟, 朱志军. 儿童肝移植受者健康相关生存质量评价的荟萃分析[J/OL]. 中华移植杂志(电子版), 2024, 18(05): 302-309.
[6] 孙璐, 蒋亚玲, 陈凌君. 布托啡诺对脑缺血再灌注损伤大鼠神经炎症和JAK2/STAT3信号通路的影响[J/OL]. 中华细胞与干细胞杂志(电子版), 2024, 14(06): 344-350.
[7] 中华医学会器官移植学分会, 中国医师协会器官移植医师分会. 肝移植术后急性移植物抗宿主病诊疗中国专家共识(2024 版)[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 1-12.
[8] 徐涵治, 邱洵, 汪恺, 徐骁. 脂肪变性供肝脱脂策略的研究[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 18-24.
[9] 伊力扎提·阿扎提, 吐尔洪江·吐逊. 腹腔镜活体供肝切取术的临床现状[J/OL]. 中华肝脏外科手术学电子杂志, 2025, 14(01): 30-35.
[10] 中华医学会器官移植学分会. 肝移植术后缺血性胆道病变诊断与治疗中国实践指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 739-748.
[11] 傅斌生, 冯啸, 杨卿, 曾凯宁, 姚嘉, 唐晖, 刘剑戎, 魏绪霞, 易慧敏, 易述红, 陈规划, 杨扬. 脂肪变性供肝在成人劈离式肝移植中的应用[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 789-794.
[12] 魏志鸿, 刘建勇, 吴小雅, 杨芳, 吕立志, 江艺, 蔡秋程. 肝移植术后急性移植物抗宿主病的诊治(附四例报告)[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 846-851.
[13] 中华医学会器官移植学分会, 中华医学会外科学分会外科手术学学组, 中华医学会外科学分会移植学组, 华南劈离式肝移植联盟. 劈离式供肝儿童肝移植中国临床操作指南[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 593-601.
[14] 刘军, 丘文静, 孙方昊, 李松盈, 易述红, 傅斌生, 杨扬, 罗慧. 在体与离体劈离式肝移植在儿童肝移植中的应用比较[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 688-693.
[15] 李京, 牛博, 刘晓蓓, 魏新雪, 黄荣. circ-SESN2 沉默靶向调控miRNA-23a-5p/ULK1 在神经细胞氧化应激损伤中的作用机制研究[J/OL]. 中华神经创伤外科电子杂志, 2024, 10(05): 263-272.
阅读次数
全文


摘要