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中华重症医学电子杂志 ›› 2017, Vol. 03 ›› Issue (02) : 94 -99. doi: 10.3877/cma.j.issn.2096-1537.2017.02.004

所属专题: 重症医学 文献

专题笔谈

移植供肝保护新进展
朱泽斌1, 赵强1, 何晓顺1,()   
  1. 1. 510080 广州,中山大学附属第一医院肝移植科
  • 收稿日期:2017-04-07 出版日期:2017-05-28
  • 通信作者: 何晓顺
  • 基金资助:
    国家自然科学基金(81170448,81471583); 公益性行业科研专项基金项目(201302009); 广东省器官捐献与移植免疫重点实验室建设项目(2013A061401007)

New progress in protection of donor liver

Zebin Zhu1, Qiang Zhao1, Xiaoshun He1,()   

  1. 1. Organ Transplantation Center, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, China
  • Received:2017-04-07 Published:2017-05-28
  • Corresponding author: Xiaoshun He
  • About author:
    Corresponding author: He Xiaoshun, Email:
引用本文:

朱泽斌, 赵强, 何晓顺. 移植供肝保护新进展[J/OL]. 中华重症医学电子杂志, 2017, 03(02): 94-99.

Zebin Zhu, Qiang Zhao, Xiaoshun He. New progress in protection of donor liver[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), 2017, 03(02): 94-99.

肝移植是治疗终末期肝病唯一有效的方法,随着肝移植技术的不断提高,适应证的不断扩大,术后预后的不断改善,等待肝移植的患者越来越多,因此移植界面临供体严重不足的问题。肝缺血再灌注损伤(IRI)严重制约"边缘"供肝的利用,最大限度减少供肝缺血再灌注损伤,对于提高肝移植治疗效果具有重要意义。目前,我国移植供器官的来源为公民逝世后器官捐献。由于器官保护技术直接影响供体器官的质量及受体移植后预后,因此器官保护在器官捐献工作中有着极其重要的地位。本文就肝缺血再灌注损伤发生机制,供肝质量评估,器官获取,肝保存和修复以及器官转运几个方面的最新研究进展进行综述。

Liver transplantation is the unique effective treatment for patients with end-stage liver disease. With the improvement of operative technique, expansion of indications and improvement of postoperative outcomes, there are an increasing number of patients in liver transplant waiting lists. Consequently, shortage of donors becomes a serious issue in the liver transplantation community. Liver ischemia reperfusion injury (IRI) seriously restricts the utilizing of marginal donor liver, so minimizing liver ischemia reperfusion injury has a great significance in improving the effect of treatment of liver transplantation. At present, the organ donation after death is the only source of organ transplantation in China. Due to organ protection is directly associated with the quality of donor organs and recipients' outcomes following transplantation, it plays a crucial role during the work of organ donation. We reviewed recent progress in mechanism of liver ischemia reperfusion injury, evaluation of donor liver, organ procurement, liver preservation and retrieval, as well as the transport of the organs.

表1 药物干预减轻供肝缺血再灌注损伤的相关研究
1
Croome KP, Lee DD, Keaveny AP, et al. Improving National Results in Liver Transplantation Using Grafts From Donation After Cardiac Death Donors[J]. Transplantation, 2016, 100(12): 2640-2647.
2
Fayek SA, Quintini C, Chavin KD, et al. The Current State of Liver Transplantation in the United States: Perspective From AmericanSociety of Transplant Surgeons (ASTS) Scientific Studies Committee and Endorsed by ASTSCouncil[J]. Am J Transplant, 2016, 6(11): 3093-3104.
3
Lo CM. Expanding living donor liver transplantation[J]. Liver Transpl, 2016, 22(S1): 37-39.
4
De Carlis L, Lauterio A, De Carlis R, et al. Donation After Cardiac Death Liver Transplantation After More Than 20 Minutes of Circulatory Arrest and Normothermic Regional Perfusion[J]. Transplantation, 2016, 100(4): e21-e22.
5
Chapman JR. Organ Transplantation in China[J]. Transplantation, 2015, 99(7): 1312-1313.
6
Serracino-Inglott F, Habib NA, Mathie RT. Hepatic ischemia-reperfusion injury[J]. Am J Surg, 2001, 181(2): 160-166.
7
Lentsch AB, Kato A, Yoshidome H, et al. Inflammatory mechanisms and therapeutic strategies for warm hepatic ischemia/reperfusion injury[J]. Hepatology, 2000, 32(2): 169-173.
8
Zhai Y, Petrowsky H, Hong JC, et al. Ischaemia-reperfusion injury in liver transplantation--from bench to bedside[J]. Nat Rev Gastroenterol Hepatol, 2013, 10(2): 79-89.
9
Zhai Y, Shen XD, O′Connell R, et al. Cutting edge: TLR4 activation mediates liver ischemia/reperfusion inflammatory response via IFN regulatory factor 3-dependent MyD88-independent pathway[J]. J Immunol, 2004, 173(12): 7115-7119.
10
Tsung A, Hoffman RA, Izuishi K, et al. Hepatic ischemia/reperfusion injury involves functional TLR4 signaling in nonparenchymal cells[J]. J Immunol, 2005, 175(11): 7661-7668.
11
Liu A, Fang H, Wei W, et al. Ischemic preconditioning protects against liver ischemia/reperfusion injury via heme oxygenase-1-mediated autophagy[J]. Crit Care Med, 2014, 42(12): e762-e771.
12
Kang JW, Cho HI, Lee SM. Melatonin inhibits mTOR-dependent autophagy during liver ischemia/reperfusion[J]. Cell Physiol Biochem, 2014, 33(1): 23-36.
13
Lué A, Solanas E, Baptista P, et al. How important is donor age in liver transplantation?[J]. World J Gastroenterol, 2016, 22(21): 4966-4976.
14
Firl DJ, Hashimoto K, O′Rourke C, et al. Impact of donor age in liver transplantation from donation after circulatory death donors: A decade of experience at Cleveland Clinic[J]. Liver Transpl, 2015, 21(12): 1494-1503.
15
Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index[J]. Am J Transplant, 2006, 6(4): 783-790.
16
Campos-Varela I, Dodge JL, Stock PG, et al. Key donor factors associated with graft loss among liver transplant recipients with human immunodeficiency virus[J]. Clin Transplant, 2016, 30(9): 1140-1145.
17
Li Z, Hu Z, Xiang J, et al. Use of hepatitis B surface antigen-positive grafts in liver transplantation: a matched analysis of the US National database[J]. Liver Transpl, 2014, 20(1): 35-45.
18
Stepanova M, Sayiner M, de Avila L, et al. Long-term outcomes of liver transplantation in patients with hepatitis C infection are not affected by HCV positivity of a donor[J]. BMC Gastroenterol, 2016, 16(1): 137.
19
Olmedilla L, Lisbona CJ, Pérez-Peña JM, et al. Early Measurement of Indocyanine Green Clearance Accurately Predicts Short-Term Outcomes After Liver Transplantation[J]. Transplantation, 2016, 100(3): 613-620.
20
Olmedilla L, Pérez-Peña JM, Ripoll C, et al. Early noninvasive measurement of the indocyanine green plasma disappearance rate accurately predicts early graft dysfunction and mortality after deceased donor liver transplantation[J]. Liver Transpl, 2009, 15(10): 1247-1253.
21
Blok JJ, Detry O, Putter H, et al. Longterm results of liver transplantation from donation after circulatory death[J]. Liver Transpl, 2016, 22(8): 1107-1114.
22
Mathur AK, Heimbach J, Steffick DE, et al. Donation after cardiac death liver transplantation: predictors of outcome[J]. Am J Transplant, 2010, 10(11): 2512-2519.
23
Reich DJ, Mulligan DC, Abt PL, et al. ASTS recommended practice guidelines for controlled donation after cardiac death organ procurement and transplantation[J]. Am J Transplant, 2009, 9(9): 2004-2011.
24
van der Plaats A, ′t Hart NA, Morariu AM, et al. Effect of University of Wisconsin organ-preservation solution on haemorheology[J]. Transpl Int, 2004, 17(5): 227-233.
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 International-matched Case Analysis[J]. Ann Surg, 2015, 262(5): 764-770; discussion 770-771.
26
Nassar A, Liu Q, Farias K, et al. Impact of Temperature on Porcine Liver Machine Perfusion From Donors After Cardiac Death[J]. Artif Organs, 2016, 40(10): 999-1008.
27
Zhang ZB, Gao W, Shi Y, et al. Protective role of normothermic machine perfusion during reduced-size liver transplantation inpigs[J]. Liver Transpl, 2016, 22(7): 968-978.
28
Liu Q, Nassar A, Farias K, et al. Sanguineous normothermic machine perfusion improves hemodynamics and biliary epithelial regeneration in donation after cardiac death porcine livers[J]. Liver Transpl, 2014, 20(8): 987-999.
29
Perera T, Mergental H, Stephenson B, et al. First human liver transplantation using a marginal allograft resuscitated by normothermic machine perfusion[J]. Liver Transpl, 2016, 22(1): 120-124.
30
Verhoeven CJ, Farid WR, de Jonge J, et al. Biomarkers to assess graft quality during conventional and machine preservation in liver transplantation[J]. J Hepatol, 2014, 61(3): 672-684.
31
Ravikumar R, Jassem W, Mergental H, et al. Liver Transplantation After Ex Vivo Normothermic Machine Preservation: A Phase 1 (First-in-Man) Clinical Trial[J]. Am J Transplant, 2016, 16(6): 1779-1787.
32
Vogel T, Brockmann JG, Quaglia A, et al. The 24-hour normothermic machine perfusion of discarded human liver grafts[J]. Liver Transpl, 2017, 23(2): 207-220.
33
Bral M, Gala-Lopez B, Bigam D, et al. Preliminary Single-Center Canadian Experience of Human Normothermic Ex Vivo Liver Perfusion: Results of a Clinical Trial[J]. Am J Transplant, 2017, 17(4): 1071-1080.
34
Gringeri E, Bonsignore P, Bassi D, et al. Subnormothermic machine perfusion for non-heart-beating donor liver grafts preservation in a Swine model: a new strategy to increase the donor pool?[J]. Transplant Proc, 2012, 44(7): 2026-2028.
35
Berendsen TA, Bruinsma BG, Lee J, et al. A simplified subnormothermic machine perfusion system restores ischemically damaged liver grafts in a rat model of orthotopic liver transplantation[J]. Transplant Res, 2012, 1(1): 6.
36
Olschewski P, Gass P, Ariyakhagorn V, et al. The influence of storage temperature during machine perfusion on preservation quality of marginal donor livers[J]. Cryobiology, 2010, 60(3): 337-343.
37
Furukori M, Matsuno N, Meng LT, et al. Subnormothermic Machine Perfusion Preservation With Rewarming for Donation After Cardiac Death Liver Grafts in Pigs[J]. Transplant Proc, 2016, 48(4): 1239-1243.
38
Bruinsma BG, Yeh H, Ozer S, et al. Subnormothermic machine perfusion for ex vivo preservation and recovery of the human liver for transplantation[J]. Am J Transplant, 2014, 14(6): 1400-1409.
39
de Rougemont O, Breitenstein S, Leskosek B, et al. One hour hypothermic oxygenated perfusion (HOPE) protects nonviable liver allografts donated after cardiac death[J]. Ann Surg, 2009, 250(5): 674-683.
40
Schlegel A, Kron P, Graf R, et al. Warm vs. cold perfusion techniques to rescue rodent liver grafts[J]. J Hepatol, 2014, 61(6): 1267-1275.
41
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.
42
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.
43
Westerkamp AC, Karimian N, Matton AP, et al. Oxygenated Hypothermic Machine Perfusion After Static Cold Storage Improves Hepatobiliary Function of Extended Criteria Donor Livers[J]. Transplantation, 2016, 100(4): 825-835.
44
Monbaliu D, Heedfeld V, Liu Q, et al. Hypothermic machine perfusion of the liver: is it more complex than for the kidney?[J]. Transplant Proc, 2011, 43(9): 3445-3450.
45
Fondevila C, Hessheimer AJ, Maathuis MH, et al. Hypothermic oxygenated machine perfusion in porcine donation after circulatory determination of death liver transplant[J]. Transplantation, 2012, 94(1): 22-29.
46
Schlegel A, Kron P, Dutkowski P. Hypothermic machine perfusion in liver transplantation[J]. Curr Opin Organ Transplant, 2016, 21(3): 308-314.
47
Fukazawa K, Lang JD. Role of nitric oxide in liver transplantation: Should it be routinely used?[J]. World J Hepatol, 2016, 8(34): 1489-1496.
48
Lundberg JO, Weitzberg E, Gladwin MT. The nitrate-nitrite-nitric oxide pathway in physiology and therapeutics[J]. Nat Rev Drug Discov, 2008, 7(2): 156-167.
49
Wood KC, Gladwin MT. The hydrogen highway to reperfusion therapy[J]. Nat Med, 2007, 13(6): 673-674.
50
Zhang CB, Tang YC, Xu XJ, et al. Hydrogen gas inhalation protects against liver ischemia/reperfusion injury by activating the NF-κB signaling pathway[J]. Exp Ther Med, 2015, 9(6): 2114-2120.
51
Lee LY, Kaizu T, Toyokawa H, et al. Carbon monoxide induces hypothermia tolerance in Kupffer cells and attenuates liver ischemia/reperfusion injury in rats[J]. Liver Transpl, 2011, 17(12): 1457-1466.
52
Younis NN, Shaheen MA, Mahmoud MF. Silymarin preconditioning protected insulin resistant rats from liver ischemia-reperfusion injury:role of endogenous H2S[J]. J Surg Res, 2016, 204(2): 398-409.
53
Björnsson B, Bojmar L, Olsson H, et al. Nitrite, a novel method to decrease ischemia/reperfusion injury in the rat liver[J]. World J Gastroenterol, 2015, 21(6): 1775-1783.
54
Rocha-Santos V, Figueira ER, Rocha-Filho JA, et al. Pentoxifylline enhances the protective effects of hypertonic saline solution on liver ischemia reperfusion injury through inhibition of oxidative stress[J]. Hepatobiliary Pancreat Dis Int, 2015, 14(2): 194-200.
55
Figueira ER, Bacchella T, Coelho AM, et al. Timing-dependent protection of hypertonic saline solution administration in experimental liver ischemia/reperfusion injury[J]. Surgery, 2010, 147(3): 415-423.
56
von Frankenberg M, Golling M, Mehrabi A, et al. Donor pretreatment with gadolinium chloride improves early graft function and survival after porcine liver transplantation[J]. Transpl Int, 2003, 16(11): 806-813.
57
Luntz SP, Unnebrink K, Seibert-Grafe M, et al. HEGPOL: randomized, placebo controlled, multicenter, double-blind clinical trial to investigate hepatoprotective effects of glycine in the postoperative phase of liver transplantation [ISRCTN69350312][J]. BMC Surg, 2005, 5: 18.
58
Kotsch K, Ulrich F, Reutzel-Selke A, et al. Methylprednisolone therapy in deceased donors reduces inflammation in the donor liver and improves outcome after liver transplantation: a prospective randomized controlled trial[J]. Ann Surg, 2008, 248(6): 1042-1050.
59
Bedirli N, Ofluoglu E, Kerem M, et al. Hepatic energy metabolism and the differential protective effects of sevoflurane and isoflurane anesthesia in a rat hepatic ischemia-reperfusion injury model[J]. Anesth Analg, 2008, 106(3): 830-837.
60
Pirenne J, Monbaliu D, Aerts R, et al. Biliary strictures after liver transplantation: risk factors and prevention by donor treatment with epoprostenol[J]. Transplant Proc, 2009, 41(8): 3399-3402.
61
Nagrath D, Xu H, Tanimura Y, et al. Metabolic preconditioning of donor organs: defatting fatty livers by normothermic perfusion ex vivo[J]. Metab Eng, 2009, 11(4-5): 274-283.
62
Kong R, Gao Y, Sun B, et al. The strategy of combined ischemia preconditioning and salvianolic acid-B pretreatment to prevent hepatic ischemia-reperfusion injury in rats[J]. Dig Dis Sci, 2009, 54(12): 2568-2576.
63
D′Amico F, Vitale A, Piovan D, et al. Use of N-acetylcysteine during liver procurement: a prospective randomized controlled study[J]. Liver Transpl, 2013, 19(2): 135-144.
64
Pratschke S, Eder M, Heise M, et al. Protocol TOP-Study (tacrolimus organ perfusion): a prospective randomized multicenter trial toreduce ischemia reperfusion injury in transplantation of marginal liver grafts with an ex vivo tacrolimus perfusion[J]. Transplant Res, 2013, 2(1): 3.
65
Zhai Y, Busuttil RW, Kupiec-Weglinski JW. Liver ischemia and reperfusion injury: new insights into mechanisms of innate-adaptive immune-mediated tissue inflammation[J]. Am J Transplant, 2011, 11(8): 1563-1569.
66
Verhoeven CJ, Farid WR, de Jonge J, et al. Biomarkers to assess graft quality during conventional and machine preservation in liver transplantation[J]. J Hepatol, 2014, 61(3): 672-684.
67
Sun P, Zhang P, Wang PX, et al. Mindin deficiency protects the liver against ischemia/reperfusion injury[J]. J Hepatol, 2015, 63(5): 1198-1211.
68
Zhang B, Liu QH, Zhou CJ, et al. Protective effect of eNOS overexpression against ischemia/reperfusion injury in small-for-size liver transplantation[J]. Exp Ther Med, 2016, 12(5): 3181-3188.
69
Nemes B, Gámán G, Polak WG, et al. Extended criteria donors in liver transplantation Part I: reviewing the impact of determining factors[J]. Expert Rev Gastroenterol Hepatol, 2016, 10(7): 827-839.
70
Sibulesky L, Li M, Hansen RN, et al. Impact of Cold Ischemia Time on Outcomes of Liver Transplantation: A Single Center Experience[J]. Ann Transplant, 2016, 21: 145-151.
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