Nature:使用“生命支持系统”在体温下保存肝脏或可改善移植结果

2018-04-22 佚名 Nature自然科研

根据本周《自然》在线发表的一篇论文A randomized trial of normothermic preservation in liver transplantation,体温保存肝或有助于改善移植结果,增加可用供肝数量,从而降低等待肝移植者的死亡率。

根据本周《自然》在线发表的一篇论文A randomized trial of normothermic preservation in liver transplantation,体温保存肝或有助于改善移植结果,增加可用供肝数量,从而降低等待肝移植者的死亡率。



常温机械灌注过程中的肝;HA:肝动脉,PV:门静脉,IVC:下腔静脉,CBD:胆总管。GB:胆囊。该图片已得到捐赠者家属的同意。

肝病发病率上升使可用的供肝供不应求。许多潜在的供肝被认为风险过高,它们在冷冻保存时易受损害。而在冷冻保存期间无法测量肝的活力,因为正常的细胞活动在此期间被抑制。一种潜在解决方法是在体温下维持供肝,即通过常温机械灌注(NMP)方法为供肝提供含氧血、药物和营养素,就像为病人提供生命支持系统一样。通过这种方法可以将肝保存24个小时,而且未来这种方法也许还支持在必要时监测治疗和修复期间的肝活力。

英国牛津大学的David Nasralla及同事针对220名肝移植患者开展了首个随机试验,比较了传统冷冻存储方法和常温机械灌注方法。根据对肝损伤生物标记的测量结果,作者发现与前者相比,常温机械灌注方法对供肝的损伤少50%,肝平均保存期增加54%,器官弃用率降低50%。除此之外,作者发现在移植一年后,这两种方法在胆道并发症发病率和移植肝存活率及患者存活率方面并无显著差异。



体外保存肝。a.目前,肝脏保存在保存液中的冰上。然而,这会导致能量储存分子ATP的水平下降,有害的活性氧增加,并且在移植后血液回流时损伤线粒体细胞器。b.而利用常温机械灌注方法,捐赠者的肝脏通过机器维持在体温(37°C)下。该装置将肝脏的缺氧血液(深红色)泵输至机器,然后将含有营养素和必需元素(如胆汁盐、肝素和胰岛素)的含氧血液(浅红色)返回至肝脏。c.基于机器的器官灌注在未来可能用于移植前的肝损伤修复。

奥地利因斯布鲁克医科大学的Stefan Schneeberger在相应的新闻与观点文章中写道:“能够在接近正常条件的环境下保存器官不仅有助于增强肝移植,也有助于改进肝手术和器官护理。”

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    2018-09-19 liye789132251
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    2018-04-25 执着追梦

    学习.谢谢分享

    0

  4. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Apr 22 13:05:26 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308190, encodeId=2acc30819011, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sun Apr 22 09:48:07 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308181, encodeId=5e6f30818150, content=谢谢分享了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Sun Apr 22 09:06:05 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-24 荒郊野树

    学习

    0

  5. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Apr 22 13:05:26 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308190, encodeId=2acc30819011, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sun Apr 22 09:48:07 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308181, encodeId=5e6f30818150, content=谢谢分享了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Sun Apr 22 09:06:05 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-23 txqjm

    谢谢了.学习

    0

  6. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Apr 22 13:05:26 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308190, encodeId=2acc30819011, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sun Apr 22 09:48:07 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308181, encodeId=5e6f30818150, content=谢谢分享了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Sun Apr 22 09:06:05 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 易水河

    是个好消息啊

    0

  7. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Apr 22 13:05:26 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308190, encodeId=2acc30819011, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sun Apr 22 09:48:07 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308181, encodeId=5e6f30818150, content=谢谢分享了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Sun Apr 22 09:06:05 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 131****1460

    学习了受益匪浅

    0

  8. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Apr 22 13:05:26 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308190, encodeId=2acc30819011, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sun Apr 22 09:48:07 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308181, encodeId=5e6f30818150, content=谢谢分享了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Sun Apr 22 09:06:05 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 1ddf0692m34(暂无匿称)

    学习了,谢谢分享

    0

  9. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Apr 22 13:05:26 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308190, encodeId=2acc30819011, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sun Apr 22 09:48:07 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308181, encodeId=5e6f30818150, content=谢谢分享了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Sun Apr 22 09:06:05 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 swfzhanggui

    非常好.谢谢分享

    0

  10. 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topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://img.medsci.cn/20220115/46bcf39c32de4aa6b45c5f9d66c8ee77/6cb4a20c55bb4b7691122f47747bfca2.jpg, createdBy=9dad1662329, createdName=1ddf0692m34(暂无匿称), createdTime=Sun Apr 22 13:05:26 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308190, encodeId=2acc30819011, content=非常好.谢谢分享, beContent=null, objectType=article, channel=null, level=null, likeNumber=21, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=https://cdnapi.center.medsci.cn/medsci/head/2017/10/21/9461f3b3c9f14e1d844256cdd08f2cf3.jpg, createdBy=a30f1426910, createdName=swfzhanggui, createdTime=Sun Apr 22 09:48:07 CST 2018, time=2018-04-22, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=308181, encodeId=5e6f30818150, content=谢谢分享了解一下, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=http://thirdwx.qlogo.cn/mmopen/vi_32/Q0j4TwGTfTLbTp9nZtjwVrSZNxAXbAicnKQWnic2eBdJUQYhxO36XdkstSicr7FVF8p5ReH4omtmsbnLdvZLiaJJ1A/132, createdBy=8bff2327056, createdName=kafei, createdTime=Sun Apr 22 09:06:05 CST 2018, time=2018-04-22, status=1, ipAttribution=)]
    2018-04-22 kafei

    谢谢分享了解一下

    0