常温和低温机器 perfusion 保存与静态冷藏对于已故的捐赠脏移植的静态冷藏
Samuel J Tingle1, Emily R Thompson2, Rodrigo S Figueiredo3
1NIHR Blood and Transplant Research Unit, Newcastle University and Cambridge University, Newcastle upon Tyne, UK.
The Cochrane database of systematic reviews
|July 9, 2024
概括
连续低温机器输液 (HMP) 显著减少了延迟的移植功能,并改善了移植中的移植存活率,而不是静态冷藏 (SCS). 氧化HMP进一步有利于老年捐赠者,而末端缺血性输液显示出有限的优势.
科学领域:
- 科和移植手术 移植手术
- 器官保存和 perfusion 技术 器官保存和 perfusion 技术 器官保存和 perfusion 技术 器官保存和 perfusion 技术 器官保存和 perfusion 技术 器官保存和 perfusion 技术
- 基于证据的医学和临床试验.
背景情况:
- 移植是末期病的最佳治疗方法.
- 在运输过程中对移植物的保存至关重要,以最大限度地减少缺血症再注射损伤.
- 静态冷藏 (SCS) 是传统的方法,但机器 perfusion (MP) 提供了先进的保存.
研究的目的:
- 为了比较低温机器输液 (HMP) 和正常热机器输液 (NMP) 与移植的标准SCS.
- 评估不同MP策略在已故捐赠者移植中的有效性.
主要方法:
- 随机对照试验 (RCT) 和准RCT的系统审查和元分析.
- 在2024年6月之前搜索了柯克伦脏和移植注册表.
- 包括的研究将MP技术 (HMP,NMP) 与已故捐赠脏 (DBD和DCD) 的SCS进行了比较.
主要成果:
- 与SCS (高确定性证据) 相比,连续非氧化HMP显著降低了延迟移植功能 (DGF).
- 持续的HMP改善了一年和长期的移植存活率与SCS (高确定性证据).
- 氧化HMP在DDC捐赠者 (>50年) 中显示出额外的益处;末缺血的HMP和NMP显示出相对于SCS的有限优势.
结论:
- 连续非氧化HMP在已故捐赠者的移植中优于SCS,减少了DGF并改善了移植的存活率.
- 氧化HMP为特定的供体群体提供了增强的益处,而末缺血性输液策略需要进一步研究.
- 机器输液技术代表了移植保存和结果的重大进步.
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