HOPE Mitigates Ischemia-Reperfusion Injury in Ex-Situ Split Grafts: A Comparative Study With Living Donation in Pediatric Liver Transplantation

Transplant International Pub Date : 2024-06-07 DOI:10.3389/ti.2024.12686

G. Rossignol, Xavier Muller, M. Ruiz, S. Collardeau-Frachon, Natacha Boulanger, C. Depaulis, Térésa Antonini, R. Dubois, K. Mohkam, J. Mabrut

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Abstract

Optimizing graft preservation is key for ex-situ split grafts in pediatric liver transplantation (PSLT). Hypothermic Oxygenated Perfusion (HOPE) improves ischemia-reperfusion injury (IRI) and post-operative outcomes in adult LT. This study compares the use of HOPE in ex-situ partial grafts to static cold storage ex-situ partial grafts (SCS-Split) and to the gold standard living donor liver transplantation (LDLT). All consecutive HOPE-Split, SCS-Split and LDLT performed between 2018–2023 for pediatric recipients were included. Post‐reperfusion syndrome (PRS, drop ≥30% in systolic arterial pressure) and reperfusion biopsies served as early indicators of IRI. We included 47 pediatric recipients (15 HOPE-Split, 17 SCS-Split, and 15 LDLT). In comparison to SCS-Split, HOPE-Split had a significantly shorter cold ischemia time (CIT) (470min vs. 538 min; p =0.02), lower PRS rates (13.3% vs. 47.1%; p = 0.04) and a lower IRI score (3 vs. 4; p = 0.03). The overall IRI score (3 vs. 3; p = 0.28) and PRS (13.3% vs. 13.3%; p = 1) after HOPE-Split were comparable to LDLT, despite a longer CIT (470 min vs. 117 min; p < 0.001). Surgical complications, one-year graft, and recipient survival did not differ among the groups. In conclusion, HOPE-Split mitigates early IRI in pediatric recipients in comparison to SCS-Split, approaching the gold standard of LDLT.

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HOPE 可减轻原位分割移植物的缺血再灌注损伤：小儿肝移植中活体捐献的比较研究

优化移植物保存是小儿肝移植（PSLT）中原位劈离移植物的关键。低温氧合灌注（HOPE）可改善成人肝移植的缺血再灌注损伤（IRI）和术后效果。这项研究将低温氧合灌注用于原位部分移植物与静态冷藏原位部分移植物（SCS-Split）和金标准活体肝移植（LDLT）进行了比较。纳入了2018-2023年间为儿科受者进行的所有连续HOPE-Split、SCS-Split和LDLT手术。再灌注后综合征（PRS，收缩压下降≥30%）和再灌注活检是IRI的早期指标。我们共纳入了 47 名儿科受者（15 名 HOPE-Split、17 名 SCS-Split、15 名 LDLT）。与 SCS-Split 相比，HOPE-Split 的冷缺血时间 (CIT) 明显较短（470 分钟 vs. 538 分钟；P =0.02），PRS 率较低（13.3% vs. 47.1%；P =0.04），IRI 评分较低（3 vs. 4；P =0.03）。HOPE-Split术后的总体IRI评分（3分 vs. 3分；p = 0.28）和PRS（13.3% vs. 13.3%；p = 1）与LDLT相当，尽管CIT时间更长（470分钟 vs. 117分钟；p < 0.001）。两组的手术并发症、一年移植物存活率和受者存活率没有差异。总之，与 SCS-Split 相比，HOPE-Split 可减轻儿科受者的早期 IRI，接近 LDLT 的黄金标准。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Transplant International

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