Perfusate Flavin Mononucleotide and D-Dimer as Viability Biomarkers in Australasia's First Hypothermic Machine Perfusion Programme for Liver Transplantation

IF 1.8 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2026-09-30 DOI:10.1111/ctr.70697

Jacques Eastment, Jules Devaux, Kevin Yi, Peter Swan, John McCall, Andrew Jones, Louise Barbier

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引用次数: 0

Abstract

Hypothermic oxygenated machine perfusion (HOPE) is a simple ex-situ treatment for liver grafts. However, it lacks viability assessment capabilities. Flavin mononucleotide (FMN) and D-dimer may be useful biomarkers of graft quality during HOPE. This exploratory study aimed to determine whether effluent FMN and D-dimer concentrations were associated with outcomes in liver transplants treated with HOPE. This is a retrospective, single-center study of all grafts treated with HOPE in New Zealand from 2022-2025. Fifty-four grafts were treated with HOPE. Effluent concentrations of FMN (n = 30) and D-dimer (n = 24) were analyzed. Post-transplant cholangiopathy (PTxC) with graft loss occurred in five recipients of donation after circulatory death grafts. The median summation of FMN concentrations taken over the first two hours of perfusion was higher in the PTxC group (four PTxC events among the 30 grafts with FMN measurements; p = 0.034). Decision curve analysis suggested that summated FMN models may add net benefit over default strategies, particularly in DCD grafts, although with only five outcome events these analyses do not define implantation thresholds. D-dimer concentrations were not significantly different in PTxC grafts (p > 0.05). Whilst perfusate FMN has promise as a predictor of PTxC in HOPE grafts, especially if summated over several time points, prospective external validation is required before it could contribute to transplantation decision-making.

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灌注黄素单核苷酸和d -二聚体在澳大拉西亚首个肝移植低温机器灌注计划中的活性生物标志物。

低温氧机灌注（HOPE）是肝移植的一种简单的脱位治疗方法。然而，它缺乏可行性评估能力。黄素单核苷酸（FMN）和d -二聚体可能是HOPE移植质量的有用生物标志物。本探索性研究旨在确定流出物FMN和d -二聚体浓度是否与HOPE治疗肝移植的预后相关。这是一项回顾性的单中心研究，研究对象是新西兰2022-2025年间接受HOPE治疗的所有移植物。54例移植物用HOPE治疗。分析出水FMN （n = 30）和d -二聚体（n = 24）的浓度。移植后胆管病变（PTxC）伴移植物丢失发生在5例循环死亡移植受者中。PTxC组灌注前2小时FMN浓度的中位数总和更高（在30个FMN测量的移植物中有4个PTxC事件，p = 0.034）。决策曲线分析表明，总的FMN模型可能比默认策略增加净收益，特别是在DCD移植中，尽管只有五个结果事件，这些分析并没有定义植入阈值。d -二聚体在PTxC移植物中的浓度差异无统计学意义（p < 0.05）。虽然灌注FMN有望作为HOPE移植物PTxC的预测指标，特别是如果在几个时间点上进行汇总，但在有助于移植决策之前，需要进行前瞻性的外部验证。

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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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.