Ischemia-free liver transplantation (Reports of 3 cases)
10.3760/cma.j.issn.0254-1785.2017.10.001
- VernacularTitle:无缺血肝移植技术的创立——附三例报告
- Author:
Xiaoshun HE
1
;
Zhiyong GUO
;
Weiqiang JU
;
Linwei WU
;
Qiang ZHAO
;
Dongping WANG
;
Yi MA
;
Lu YANG
;
Maogen CHEN
Author Information
1. 中山大学附属第一医院器官移植科
- Keywords:
ischemia and reperfusion injury;
normothermic machine perfusion;
ischemia-free liver transplantation;
early prognosis
- From:
Chinese Journal of Organ Transplantation
2017;38(10):577-583
- CountryChina
- Language:Chinese
-
Abstract:
Objective Ischemia reperfusion injury (IRI) is a major limiting factor of graft survival in organ transplantation.We've established a novel procedure called ischemia-free liver transplantation (IFLT) in big animal study.In this report,we aimed to investigate the feasibility and early outcomes of IFLT.Methods We have performed 3 cases of IFLT during July 23,2017 to August 9,2017.We analyzed the surgical methods,normothermic perfusion parameters,blood gas analysis,liver function tests and complications early after liver transplantation.Pathologic studies and immunohistochemical staining of donor liver biopsies were conducted before procurement,at the end of machine perfusion,as well as after re-vascularization for evaluating IRI.Results The surgical procedures of all 3 patients were successful,without stoppage of blood supply for the liver grafts throughout organ procurement,ex vivo preservation and implantation.During normothermic perfusion,the pH value was stable within the normal range and the lactate levels dropped quickly to lower than detected (＜0.3 mmol/L) within 1.5-3 h.The livers continued to produce bile with the volume of 2-6 mL/h.Hematoxylin and eosin (HE) staining evaluation and TdT-mediated dUTP nick end labeling (TUNEL) assay of biopsies taken from liver tissues before procurement,at the end of machine perfusion and after re-vascularization,showed few necrostic and apoptotic hepatocytes in the liver biopsies.The immunohistochemical staining of IL-1β and vWF suggested no inflammatory cytokine release and sinusoidal endothelial cell activation.The three patients recovered smoothly without rejection,vascular and biliary complications.Conclusion IFLT is a feasible and effective procedure,which is able to overcome the major limitations of conventional procedure.The novel IFLT will become one of the mainstream transplant procedures in the future.
