常溫灌注（Normothermic Perfusion）

常溫灌注（Normothermic Perfusion）

Normothermic perfusion: a new paradigm for organ preservation.

Brockmann J, Reddy S, Coussios C, Pigott D, Guirriero D, Hughes D, Morovat A, Roy D, Winter L, Friend PJ.

Source: Nuffield Department of Surgery, University of Oxford, Oxford, United Kingdom.

Abstract

OBJECTIVE: Transplantation of organs retrieved after cardiac arrest could increase the donor organ supply. However, the combination of warm ischemia and cold preservation is highly detrimental to the reperfused organ. Our objective was to maintain physiological temperature and organ function during preservation and thereby alleviate this injury and allow successful transplantation.

BACKGROUND DATA: We have developed a liver perfusion device that maintains physiological temperature with provision of oxygen and nutrition. Reperfusion experiments suggested that this allows recovery of ischemic damage.

METHODS: In a pig liver transplant model, we compared the outcome following either conventional cold preservation or warm preservation. Preservation periods of 5 and 20 hours and durations of warm ischemia of 40 and 60 minutes were tested.

RESULTS: After 20 hours preservation without warm ischemia, post-transplant survival was improved (27%-86%, P = 0.026), with corresponding differences in transaminase levels and histological analysis. With the addition of 40 minutes warm ischemia, the differences were even more marked (cold vs. warm groups 0% vs. 83%, P = 0.001). However, with 60 minutes warm ischemia and 20 hours preservation, there were no survivors. Analysis of hemodynamic and liver function data during perfusion showed several factors to be predictive of posttransplant survival, including bile production, base excess, portal vein flow, and hepatocellular enzymes.

CONCLUSIONS: Organ preservation by warm perfusion, maintaining physiological pressure and flow parameters, has enabled prolonged preservation and successful transplantation of both normal livers and those with substantial ischemic damage. This technique has the potential to address the shortage of organs for transplantation.

常溫灌注 換腎新希望

2012/03/09 

聯合報╱編譯王麗娟／綜合報導

英國專家8日宣佈以常溫灌注的新技術，成功讓17名病患接受腎臟移植手術，為全球第一批。常溫灌注技術不僅可提高腎臟移植的成功率，且可讓等候移植的名單縮短10%。

56歲的黛博拉‧貝克威爾23歲診斷出罹患罕見的遺傳病多囊腎病，此病會逐漸導致腎功能衰竭，接受腎移植前，貝克威爾已每晚洗腎9小時長達兩年。

貝克威爾在成為以常溫灌注（normothermic perfusion）技術進行腎臟移植手術的病患後，人生從黑白再度變為彩色。17名動手術者為5男12女，全在英國的萊斯特綜合醫院（Leicester General Hospital ）接受手術，時間從2010年11月至2011年11月，但醫生8日首度對外公佈結果。

常溫灌注技術由於可讓因為冷藏保存而受損的腎臟復原部分受損的功能，進而降低移植後出現排斥的機會。此外，一些原本不太可能用來移植的腎臟，例如患有高血壓、糖尿病老人捐贈的腎臟，也可以常溫灌注技術，提高受損腎臟的功能，讓可供移植的腎臟增多，預估每年可增加500個，縮短等候移植的名單。

多數的腎臟移植為活體移植，但越來越多醫生嘗試用死者移植。上述英國專家進行的常溫灌注研究即是以死者移植進行。

常溫灌注技術是將冷藏的腎臟，以氧合的血加以加溫，逆轉腎臟因低溫冷藏造成的損害。利用這項技術，專家可在受到控制的狀況下，於體外緩漫將血液輸入捐贈者的腎臟，不僅可逆轉冷藏的損害，還可先對腎臟施加抗發炎等藥劑，再動移植手術。