肝移植供体保存技术及进展

Donor Preservation Technology and Progress of Liver Transplantation

摘要: 目的：肝移植是终末期肝病和肝恶性肿瘤的最终选择。肝移植技术得到了显著改善，但移植后并发症仍不可避免。移植供体的保存是肝移植的基础，随着器官供需矛盾的日益加剧，边缘化、脂肪变性和心脏循环死亡的供体增加，我们迫切需要更有效、更低成本的保存技术来延长供体缺血时间。本研究介绍了几种经典保存技术的发展过程、几种新的保存方案的进展以及几种保存方案之间的差异，旨在探索更合适的保存技术来指导临床实践，减少资源浪费。方法：通过PubMed、维普、中国知网、万方、重庆医科大学图书馆数据库进行了系统文献检索(1960~2022)，纳入UW液、HTK液、Celsior液、HTK-N、IGL-1液、Polysol液、SCOT液、CZ-1液等或比较两种或多种保存液的文章。结果：共有387篇论文关于UW液、HTK液95篇，Celsior液46篇，HTK-N液12篇，IGL-1液45篇，Polysol液8篇，SCOT液20篇，CZ-1液2篇和102篇HMP和74篇多种保存技术的比较研究。目前临床应用较多的的有HTK液、UW液和Celsior液，两者之间的差异较小，但对肝脏的缺血–再灌注损伤仍然存在。新型溶液有HTK-N、IGI-L液、Polysol液、SCOT液、CZ-1液等。HMP作为最新动态保存方式，也逐渐应用于临床。几种保存技术各有优缺点。结论：已用于临床的HTK液、UW液和Celsior液之间差异性较小，IGL-I液除UW液和Celsior的优点外，还减少高钾血症和钙离子超载的发生，具有更好的器官冲洗效果，更好地减少缺血再灌注损伤。其他技术在动物实验和临床试验中逐渐显示出其优势。HMP作为最新的动态保存模式，可降低肝细胞和内皮细胞损伤。然而，目前理论上有效的保存方案仍处于实验阶段，存在许多不确定性，因此需要更深入的探索。

Abstract: Background: Liver transplantation is the final choice for end-stage liver disease and liver malignan-cies. At present, liver transplantation technology has been significantly improved, but post- trans-plant complications are still inevitable. The preservation of transplanted donors is the basis of or-gan transplantation techniques and the quality of donor preservation is one of the most important factors affecting the outcome of liver transplantation. With the increasingly imbalance between or-gan supply and demand, the increasing supply liver of marginalization, fatty degeneration and more cardiac circulation death donor, we desperately need more effective, low-cost preservation techniques to prolonged donor ischemia time. The development process of several classical preser-vation techniques, the advance of several new preservation solutions and the differences between several solutions are introduced in this study and which aims to explore more appropriate preser-vation techniques to guide clinical practice and reduce resource waste. Methods: PubMed, VIP, CNKI, Wanfang, Embase and Chongqing Medical University library databases were utilized. Articles from 1960 to 2022 which contain the controduction of UWs, HTKs, Celsior solution, HTK-N solution, IGL-1 solution, Polysol solution, SCOT solution, and CZ-1 solution or comparing graft outcomes between two or more different perfusion/preservation solutions were included. Results: There are 387 pa-pers about UW solution, 95 papers about HTK solution, 46 papers about Celsior solution, 12 papers about HTK-N solution, 45 papers about IGL-1 solution, 8 papers about Polysol solution, 20 papers about SCOT solution, 2 papers about CZ-1 solution and 102 papers about HMP and 74 of them are comparative studies about multiple preservation techniques. At present, HTK, UW and Celsior solu-tions are widely used in clinical, and the new solutions are HTK-N, IGI-L, Polysol, SCOT, CZ-1, etc. The difference between them is small, but the ischemia-reperfusion injury of the liver still remains. However, many of new solutions include HTK-N, IGI-L, Polysol, SCOT, CZ-1, etc. had been researched. As the latest dynamic preservation mode, HMP is also gradually applied in clinical practice. Conclu-sion: The HTKs, UWs and Celsior solution that have been used in clinical practice are less different. As for the new solutions, IGL-I, with the advantages of both UW fluid and Celsior, which can reduce the occurrence of hyperkalemia and calcium ion overload, have a better organ flushing effect, and better reduce ischemia and reperfusion injury. Other solutions have gradually shown their ad-vantages in animal experiments and clinical trials. As the latest dynamic preservation mode, HMP can reduce the hepatocyte and endothelial cell damage. However, the current theoretical effective preservation solutions are still in the experimental stage with many uncertainties and thus require more intensive exploration.