探讨常温机械灌注（NMP）对临床弃肝的保存及修复作用。

收集中山大学附属第一医院2015年3月至2016年2月间家属同意捐献但不适宜做临床肝移植的3例心脏死亡供者（DCD）供肝进行NMP保存6 h。检测灌注过程中NMP保存液中血糖、乳酸、尿素氮、总胆红素（TBIL）、白蛋白（ALB）、丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）、肝组织三磷酸腺苷（ATP）浓度；记录胆汁生成量，并检测胆汁中TBIL、碳酸氢盐、γ-谷氨酰转移酶（GGT）；观察灌注前后肝组织病理变化、细胞凋亡和氧化应激情况，

3例临床弃肝经NMP后发现ALT、AST、TBIL浓度在开始灌注后呈现上升趋势，随后维持相对稳定状态，ALB浓度在灌注过程中由6.00（4.00~8.00）g/L增加到23.33（17.00~27.00）g/L，血糖增加到12.07（10.60~13.90）mmol/L，呈现高糖状态。尿素氮也不断累积浓度达262.3（216.0~325.0）mg/L。肝组织ATP水平由灌注前的56.95（44.21~70.89）μmol/g增加至311.85（276.61~358.08）μmol/g。乳酸浓度则由开始的6.70（2.60~12.60）mmol/L，降至灌注末期的2.5（0.3~5.4）mmol/L。随着灌注时间的延长，胆汁的产生逐渐增多，灌注6 h胆汁产生量为8.87（7.30~10.30）ml，而且胆汁的颜色较深，呈黏稠状，伴随着胆汁中的TBIL浓度和碳酸氢盐浓度逐渐升高，而反映胆管损伤指标的γ-GGT浓度则随着灌注时间的延长而减少，灌注6 h γ-GGT浓度减少为64.96（38.5~107.5）U/L。同时灌注后的氧化应激反应［高迁移率族蛋白1（HMGB1）、8-羟基脱氧鸟苷（8-OHdG）浓度］以及炎症反应程度［白介素6（IL-6）、肿瘤坏死因子α（TNF-α）浓度］均维持在较低水平。

NMP实现了对DCD供肝移植前的评估，并且对供肝的选择、治疗干预以及预处理提供了新方法，NMP不仅改善了器官质量和功能，也为扩大供肝来源提供了新的途径。

To investigate the effect of normothermic machine perfusion (NMP) on preservation and repair of discarded human donor livers.

Three discarded human donor livers after cardiac death (DCD) from March 2015 to February 2016 in the First Affiliated Hospital of Sun Yat-sen University were treated with NMP for 6 hours. Glucose, lactate, urea, aspartate transaminase (AST), alanine transaminase (ALT), total bilirubin (TBIL), albumin (ALB), adenosine triphosphate (ATP), hourly bile production and total bilirubin, bicarbonate, gamma glutamyl transferase (γ-GGT) in bile were recorded during NMP. And the change of liver histology, cell apoptosis, oxidative stress markers after NMP were also analyzed.

AST/ALT and TBIL initially increased and then remained at a stable level. ALB increased from 6.00 (4.00-8.00) g/L to 23.33 (17.00-27.00) g/L during the perfusion and glucose increased to 12.07 (10.60-13.90) mmol/L at the end of perfusion, as well as urea increased to 262.3 (216.0-325.0) mg/L. The level of ATP in the liver increased from 56.95 (44.21-70.89) μmol/g tissue to 311.85 (276.61-358.08) μmol/g tissue. However, lactate concentration decreased to 2.5 (0.3-5.4) mmol/L, which reflecting active metabolism. With time prolongation of perfusion, the bile production raised gradually, with total amount of 8.87 (7.30-10.30) ml during all 6 h perfusion. The bile is dark and viscous, accompanied by increased concentration of TBIL and bicarbonate in the bile during the perfusion. γ-GGT, which is a marker of bile injury, decreased to 64.96 (38.5-107.5) U/L at the end of perfusion. The liver histological results showed a well-preserved liver morphology without injury before and after perfusion. The apoptotic cell number decreased and the oxidative stress (high mobility group box-1 protein and 8-hydroxy-2′-deoxyguanosine levels) and inflammatory cytokine (interleukin-6 and interleukin-8) concentration were maintained at a relatively low level after the perfusion.

NMP help to assess the DCD donor liver before transplantation and provides a new approach of donor selection, treatment interventions, and pretreatment. It not only improves organ quality and function but also provides a new way to expand the donor liver.