常温机械灌注修复边缘性供肝的临床疗效：单中心报道

目的探讨常温机械灌注（normothermic machine perfusion, NMP）修复边缘性供肝的安全性和有效性。 方法2018年9月至2019年9月，使用NMP进行6例边缘性供肝体外评估和修复，供肝来自4例心死亡和2例高胆红素血症患者。记录灌注过程的灌注参数、灌注液血气分析及生化检验指标，结合供肝外观等评估边缘性供肝是否适合移植。术后随访至少3个月，记录移植后7 d内肝功能指标、生化指标、并发症发生情况等。 结果NMP期间灌注参数稳定，肝动脉灌注流量为110~334 ml/min，门静脉灌注流量为540~1 180 ml/min。灌注液pH、PO₂、PCO₂在灌注0.5 h后基本恢复正常，乳酸水平迅速下降；肝酶水平无明显升高，胆汁pH>7.5。所有供肝灌注均匀，质地柔软，均被用于移植。受者肝移植后恢复情况良好，无一例发生原发性移植肝无功能或缺血性胆道病变，至末次随访所有患者及移植物均存活。 结论本科室在临床肝移植中应用NMP技术的初步经验提示，NMP用于边缘性供肝的保存是安全、有效的。

Clinical outcomes of liver transplantation using normothermic machine perfusion: A single center report

ObjectiveTo investigate the safety and efficacy of normothermic machine perfusion (NMP) in resuscitation of marginal donor livers. MethodsFrom September 2018 to September 2019, NMP was used for in vitro evaluation and repair of six marginal donor livers. Four livers derived from donation after circulatory death patients, and two from hyperbilirubinemia patients. The perfusion parameters were recorded. Blood gas analysis and biochemical test, bile production were performed to evaluate the viability of the marginal donor livers. All patients were followed up for at least three months after transplantation. Liver function, blood gas indexes and complications were recorded within 7 days after transplantation. ResultsThe perfusion parameters were stable during NMP, with hepatic arterial and portal vein perfusion flows of 110-334 ml/min and 540-1 180 ml/min, respectively. pH, PO₂, PCO₂ returned to normal range after 0.5 hour of perfusion and the lactate levels declined rapidly. There was no significant increase in liver enzymes and pH values of bile produced by livers were higher than 7.5. All the recipients had uneventful recovery from liver transplantation, and no patient suffered from primary nonfunction or ischaemic cholangiopathy. All the patients and grafts survived. ConclusionThe preliminary experience of liver transplantation using NMP in our department suggests that NMP is safe and effective in resuscitating marginal donor livers.