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在循环死亡之后的捐赠肝脏移植在ex situ常热机器输液过程中用alteplase治疗

Rachel Todd^1,2, Leonie van Leeuwen¹, Andrew Rosowicz²

¹Recanati/Miller Transplantation Institute, The Mount Sinai Hospital, New York, New York, USA.

Clinical transplantation

|August 20, 2025

概括

在肝脏正常热器输液 (NMP) 期间使用组织等离子激素激活剂 (tPA) 是安全有效的. 这种方法减少了接受者对tPA的暴露,在循环死亡肝移植后提供了更安全的捐赠替代方案.

科学领域:

肝胆外科手术
器官移植
机器输液技术

背景情况:

在循环死亡 (DCD) 后,Normothermic机器输液 (NMP) 提高了捐赠肝脏的利用率.
组织等离子体激活剂 (tPA) 传统上给予DCD接受者,以预防非阻塞性胆道并发症 (NAS).
在NMP期间使用tPA可能会减少接受者的全身暴露.

研究的目的:

评估在DCD肝脏中使用tPA的安全性和有效性.
为了比较NMP与tPA,NMP没有tPA和历史非NMP DCD肝脏组之间的临床结果和化学成分.

主要方法:

使用OrganOx metra对127个肝脏输液进行了回顾性分析.
在NMP期间接受tPA的DCD肝脏 (tPA- NMP- DCD).
在脑死亡后的捐赠者接受了没有tPA的NMP (NMP-DBD).
78例非NMP DCD肝脏用tPA (tPA- DCD) 作为比较剂.

主要成果:

在tPA- NMP- DCD和NMP- DBD组之间30天或3个月的患者/ 移植存活时间没有显著差异.
与历史的tPA- DCD相比,tPA- NMP- DCD组的血小板和冷血流量有所减少.
在tPA- DCD组中有一种主要的非功能性疾病;在tPA- NMP- DCD组中有一种需要重新移植的缺血性胆血管病.
在NMP-DBD队列中,血液瘤疏散的再手术率更高.

结论:

NMP提供了一个可行的平台,用于向捐赠肝脏注射tPA,从而最大限度地降低接受者的风险.
这种方法为使用tPA进行DCD肝移植的中心提供了更安全的替代方案,避免了接受者的全身暴露.

关键词:

胆道在循环死亡后的捐赠在肝脏内在手术期间输血缺血性胆血管病变肝脏移植没有缩的狭窄性常温机器输液器官的保存

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