Summary of the research frontiers of liver transplantation in 2020 ATC / 器官移植

The American Transplant Congress (ATC) is an influential academic congress in the field of organ transplantation. In this article, the hotspots of liver transplantation in 2020 ATC were summarized, including the latest research progress in donor liver procurement and quality assessment, donor liver preservation and ischemia-reperfusion injury (IRI), liver transplantation for hepatocellular carcinoma and other hepatic malignancies, complications after liver transplantation, transplantation immunology, perioperative management and donor-derived infection, pediatric liver transplantation and cell therapy, etc.

Application of dual hypothermic oxygenated machine perfusion in ex vivo split liver transplantation / 器官移植

The technology of split liver transplantation is becoming increasingly mature with rapid development. During ex vivo splitting, the depletion of intracellular energy sources [such as adenosine triphosphate (ATP)] and other metabolic disorders may lead to cell damage and dysfunction, which will be aggravated by reperfusion injury of liver transplantation, clinically manifested as postoperative complications and transplantation failure. To further improve the quality of donor liver in ex vivo split liver transplantation, research teams at home and abroad apply machine perfusion to enhance the quality of donor liver. In this article, the research progresses worldwide on machine perfusion of donor liver in ex vivo split liver transplantation were reviewed, and the application and prospect of dual hypothermic oxygenated machine perfusion (D-HOPE) in ex vivo split liver transplantation were elucidated, aiming to provide reference for increasing the source of donor liver for ex vivo split liver transplantation and further resolving the current status of donorliver shortage.

Prevenção de isquemia hepática normotérmica durante perfusão hepática in situ com três diferentes soluções de preservação: análise experimental através de termografia por radiação infravermelha em tempo real / Prevention of normothermic hepatic ischemia during in situ liver perfusion with three different preservation solutions: experimental analysis by realtime infrared radiation thermography

OBJETIVO: Determinar a aplicabilidade da termografia por radiação infravermelha no monitoramento da perfusão hepática in situ com diferentes soluções de preservação. MÉTODOS: 24 ratos Wistar machos adultos, foram distribuidos aleatoriamente em quatro grupos de seis animais: grupo EC; ®grupo CUST; ®grupo CEL e grupo RL. Todas as soluções estavam resfriadas à exatamente 4ºC e posicionadas 20 cm acima do nível do fígado. As imagens infravermelhas, com as respectivas avaliações de temperatura da superfície hepática, foram captadas em tempo real : imediatamente após a laparotomia; após a canulação dos vasos e imediatamente antes da infusão; a cada minuto cronometrado após início da infusão até o quinto minuto de infusão. As médias de temperaturas de cada momento foram comparadas intra e intergrupos através do teste da Diferença entre médias de distribuição normal, com nível de significância p 0,05. RESULTADOS: Houve diferença entre as temperaturas do momento da laparotomia e imediatamente após a canulação; entre este último e após o primeiro minuto de perfusão; e entre as medidas ao final do primeiro e do quinto minutos de perfusão em todos os grupos. O grupo CEL mostrou diferença significativa adicional entre as temperaturas medidas ao final do primeiro e do segundo minutos. CONCLUSÃO: Foi possível avaliar o resfriamento hepático durante a perfusão das soluções de preservação utilizando-se a radiação infravermelha. As soluções tiveram comportamento semelhante entre si, com a solução Celsior® mostrando potencial adicional de resfriamento significativo até ao final do segundo minuto.

OBJECTIVE: To establish the usefulness of infrared radiation thermography on monitoring in situ liver perfusion with different preservation solutions during liver harvesting. METHODS: Twenty-four adult male Wistar rats, weighing 385.31g were randomly divided into four groups of six animals each according to the solution used to perfuse the liver (Euro-Collins® solution - EC group; Custodiol® solution - CUST group; Celsior® solution - CEL group and Ringer-Lactate solution - RL group). Under inhalatory ether anesthesia, animals were submitted to upper transversal laparotomy, exposure of median and left-lateral hepatic lobes, heparin injection (500 UI/Kg) through infrahepatic vena cava, portal vein infusion through 18G catheter of cold (4°C) solution according to the group of study. Infrared images, with respective temperature avaliations from hepatic surface, were picked up in real time by Therma CAM SC500® infrared camera positioned at constant distance from three fixed points of the diaphragmatic surface of median and left lateral lobes at the following moments regarding liver perfusion: immediately after laparotomy; after portal vein cannulation and immediately before solution infusion; at each minute from the beginning of liver perfusion during five minutes. Mean temperatures of each moment were compared intra and intergroups with the difference between means test with normal distribution, with significance level of 5 percent (p=0.05). RESULTS: There was statistically significant difference of means temperatures between the moment of laparotomy and immediately after cannulation; between this later and after the first minute of perfusion; and between the first and fifth minutes of infusion in all groups of study in a similar way. CEL group showed additional difference between the first and second minutes means temperatures. Intergroup comparison showed Euro-Collins solution with significant less cooling power when compared to all others...

Effect of liver preservation in SX-1 solution in rats / 国际外科学杂志

Objective To compare the efficacy of liver preservation in SX-1 solution,HC-A solution and UW solution in the two-cuff technique orthotopic liver transplantation model in rats.Methods We confected SX-1 solution using of aseptic technique and built up two-cuff technique orthotopie liver transplantation model in rats.The SX-1 solution,UW solution and HC-A solution preserved rats livers in 2 h,8 h and 24 h,then went orthotopic liver transplantation.The various hepatic indices were determined when the rats survived for 6 hours after the operation.Results For the ALT,AST,the SX-1 solution group(2 h,8 h,24 h)and UW solution group went up synchronously,there was no statistical significance,(P＞0.05).Compared with HC-A solution group the SX-1 solution group (2 h,8 h,24 h)has already shown the statistical signifcance(P＜0.05).For the LDH,the SX-1 solution group (2 h,8 h,24 h)and HC-A solution group went up synchronously,there was no statistical significance(P＞0.05).Compared with UW solution group the SX-1 solution group(2 h,8 h,24 h)has already shown the statistical significance(P＜0.05).For the number of liver with bile production,each group didn1 show the statistical significance (P＜0.05).The time of preserving liver increased with the number of liver with bile production reducing.Conclusions Confirmed by the orthotopie liver transplantation model in rat,the SX-1 solution is the same as the UW solution in the indices of hepatic enzymologists.exceeding the HC-A solution.The SX-1 solution is the same as HC-A solution and UW solution in the number of liver with bile production.

The management of donor livers in living related donor liver transplantation / 中华器官移植杂志

Objective To investigate the management of donor livers in partial living liver transplantation.Methods Nine cases of partial living related donor liver transplantation in Kyoto University served as subjects.The donor liver perfusion time and method,and preparation and preservation were studied.Results The donor livers in 9 cases were successfully removed with the liver removal accounting for 20%to 29%of the total livers.The recipients were alive well.Conclusion The donor liver perfusion time and method.and preparation and preservation were the keys in partial living related donor liver transplantation.