论文标题：Transplantation of discarded livers following viability testing with normothermic machine perfusion

期刊：

作者：Hynek Mergental, Richard W. Laing et al.

发表时间：2019/06/16

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根据《自然-通讯》发表的一项研究Transplantation of discarded livers followingviability testing with normothermic machine perfusion，对供肝功能进行评估，或许可以鉴定出原本依据现行临床实践会被判为不适合移植、但是实际上适合移植的肝脏。这项发现或许可以扩大可供移植的供肝资源。

缺少合适的供肝，限制了患者的肝移植。但是，部分供肝在主观的临床评判基础上被判定为不适合移植，因而被废弃。从这些被废弃的供肝中鉴定出可以安全移植的那些，是一项重大的临床挑战。

英国伊丽莎白女王医院的Hynek Mergental、英国伯明翰大学的Darius Mirza和英国伊丽莎白女王医院的Simon Afford等人评估了对常温机械灌注（normothermic machine perfusion）期间作为供肝能标记的乳酸清除进行测量，看是否有助于从被废弃的供肝中鉴定出合适的供肝。通过这种方法，他们在被评估的31个供肝中，鉴定出了22个适合移植的，并且在临床试验中成功地将它们移植到患者（46-65岁）身上。移植90天后，无一患者发生早期移植失败，但是7名患者发生早期移植功能不良。在后期阶段的进一步跟踪调查中，4名患者出现了一种严重的并发症——非吻合口胆道狭窄（non-anastomotic biliary strictures），需要再进行一次肝移植。这项临床试验没有包括随机对照组，但是作为比较，有一组患者移植了符合现行临床标准的肝脏，其中出现早期移植功能不良和非吻合口胆道狭窄的病例较少。

患者临床试验流程图 | credit: Mergental et al.

作者总结表示，在供肝保存期间对其功能进行评估，或许可以从不满足现行临床标准的供肝中鉴定出合适的供肝。但是，未来还需要开展进一步的研究，以鉴定出敏感的生物标记，最终实现长期的移植存活率。

摘要：

There is a limited access to liver transplantation, however, many organs are discarded based on subjective assessment only. Here we report the VITTAL clinical trial (ClinicalTrials.gov number NCT02740608) outcomes, using normothermic machine perfusion (NMP) to objectively assess livers discarded by all UK centres meeting specific high-risk criteria. Thirty-one livers were enroled and assessed by viability criteria based on the lactate clearance to levels ≤2.5 mmol/L within 4 h. The viability was achieved by 22 (71%) organs, that were transplanted after a median preservation time of 18 h, with 100% 90-day survival. During the median follow up of 542 days, 4 (18%) patients developed biliary strictures requiring re-transplantation. This trial demonstrates that viability testing with NMP is feasible and in this study enabled successful transplantation of 71% of discarded livers, with 100% 90-day patient and graft survival; it does not seem to prevent non-anastomotic biliary strictures in livers donated after circulatory death with prolonged warm ischaemia.

（来源：明升手机版(明升中国)）