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

doi:10.3877/cma.j.issn.1674-0793.2020.04.010

Abstract

Abstract:

Objective

To investigate the safety and efficacy of normothermic machine perfusion (NMP) in resuscitation of marginal donor livers.

Methods

From 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.

Results

The 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.

Conclusion

The preliminary experience of liver transplantation using NMP in our department suggests that NMP is safe and effective in resuscitating marginal donor livers.

Key words: Marginal donor livers, Normothermic machine perfusion, Liver transplantation, Early allograft dysfunction, Primary nonfunction

Caihui Zhu, Linhe Wang, Zhiheng Zhang, Tianyuan Qi, Weiqiang Ju, Zhiyong Guo, Xiaoshun He. Clinical outcomes of liver transplantation using normothermic machine perfusion: A single center report[J]. Chinese Archives of General Surgery(Electronic Edition), 2020, 14(04): 280-285.

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URL: https://zhptwkxwx.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-0793.2020.04.010

https://zhptwkxwx.cma-cmc.com.cn/EN/Y2020/V14/I04/280

Figures/Tables 7

References 20

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供受体基线		例1	例2	例3	例4	例5	例6
供体		?	?	?	?	?	?
?	类型	心死亡捐献	心死亡捐献	心死亡捐献	脑死亡捐献	心死亡捐献	脑死亡捐献
?	年龄(岁)	22	20	26	19	58	47
?	性别	女	男	女	男	男	男
?	死因	脑血管意外	脑血管意外	主动脉夹层	颅脑损伤	脑血管意外	脑干出血
?	热缺血时间(min)	22	10	6	0	5	0
?	冷缺血时间(h)	10.63	9.00	7.00	5.50	4.00	5.50
?	灌注原因	心死亡捐献	心死亡捐献	心死亡捐献	高胆红素血症	心死亡捐献	高胆红素血症
?	灌注时间(min)	260	260	380	360	400	320
受体		?	?	?	?	?	?
?	年龄(岁)	28	64	58	57	34	62
?	性别	男	男	男	男	男	女
?	诊断	ACLF	HCC	HCC	HCC	ACLF	ICC
?	手术方式	背驮式	背驮式	经典式	经典式	背驮式	背驮式
?	机械通气时长(h)	62.93	17.38	20.18	10.35	13.85	7.68
?	重症监护时长(h)	83.97	35.65	27.55	61.95	34.50	24.30
?	住院时间(d)	24	15	16	18	17	24

供受体基线		例1	例2	例3	例4	例5	例6
供体		?	?	?	?	?	?
?	类型	心死亡捐献	心死亡捐献	心死亡捐献	脑死亡捐献	心死亡捐献	脑死亡捐献
?	年龄(岁)	22	20	26	19	58	47
?	性别	女	男	女	男	男	男
?	死因	脑血管意外	脑血管意外	主动脉夹层	颅脑损伤	脑血管意外	脑干出血
?	热缺血时间(min)	22	10	6	0	5	0
?	冷缺血时间(h)	10.63	9.00	7.00	5.50	4.00	5.50
?	灌注原因	心死亡捐献	心死亡捐献	心死亡捐献	高胆红素血症	心死亡捐献	高胆红素血症
?	灌注时间(min)	260	260	380	360	400	320
受体		?	?	?	?	?	?
?	年龄(岁)	28	64	58	57	34	62
?	性别	男	男	男	男	男	女
?	诊断	ACLF	HCC	HCC	HCC	ACLF	ICC
?	手术方式	背驮式	背驮式	经典式	经典式	背驮式	背驮式
?	机械通气时长(h)	62.93	17.38	20.18	10.35	13.85	7.68
?	重症监护时长(h)	83.97	35.65	27.55	61.95	34.50	24.30
?	住院时间(d)	24	15	16	18	17	24

成分	用量
洗涤红细胞	6~10 U
4%琥珀酰明胶注射液	600~1 200 ml
5%碳酸氢钠注射液	100~120 ml
肝素钠注射液(1 ml12 500 U)	37 500 U
葡萄糖酸钙注射液(10 ml 1 g)	40 ml
硫酸镁注射液(10 ml 2.5 g)	4 ml
注射用甲泼尼龙琥珀酸钠(500 mg)	250~500 mg
多种微量元素注射液(Ⅱ)	10 ml
甲硝唑注射液(100 ml 0.5 g)	100 ml
注射用亚胺培南西司他丁钠(500 mg)	1 g
氨基酸注射液(250 ml 12.5 g)	125~250 ml

成分	用量
洗涤红细胞	6~10 U
4%琥珀酰明胶注射液	600~1 200 ml
5%碳酸氢钠注射液	100~120 ml
肝素钠注射液(1 ml12 500 U)	37 500 U
葡萄糖酸钙注射液(10 ml 1 g)	40 ml
硫酸镁注射液(10 ml 2.5 g)	4 ml
注射用甲泼尼龙琥珀酸钠(500 mg)	250~500 mg
多种微量元素注射液(Ⅱ)	10 ml
甲硝唑注射液(100 ml 0.5 g)	100 ml
注射用亚胺培南西司他丁钠(500 mg)	1 g
氨基酸注射液(250 ml 12.5 g)	125~250 ml

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