Prospects for the ex situ liver machine perfusion in Brazil

ABSTRACT Brazil, like most countries in the world, experiences the expansion of extended criteria donors, mainly due to the aging of the population and the obesity epidemic. Concerns regarding the quality of these organs along with the vast territorial areas of the country compromise the utilization rate of livers from donors and aggravate the discrepancy between the number of liver transplants performed and the needed. Ex situ liver machine perfusion offers superior preservation for livers from extended criteria donors, limiting cold ischaemia time and offering the possibility of evaluation of their function before transplantation as well as the reconditioning of marginal organs. Objections such as the financial cost, difficulty in transporting the device between hospitals, and demand of trained professionals in the handling of the device must be pondered with the possibility of increasing the number of transplants and the utilisation rate of donor organs. The optimal use of this resource, through the careful selection of donors and the appropriate technical and scientific knowledge, can ensure an effective and successful implementation of this technology.

【摘要】与世界多数国家一样，巴西正面临扩展标准供体（extended criteria donors）数量不断增加的局面，这主要归因于人口老龄化与肥胖症流行。对这类供体器官质量的担忧，加之该国广袤的领土范围，拖累了供体肝脏的利用率，并加剧了已实施肝移植数量与临床实际需求之间的差距。离体肝脏机器灌注（ex situ liver machine perfusion）可为扩展标准供体肝脏提供更优质的保存效果，既能缩短冷缺血时间（cold ischaemia time），又可在移植前评估器官功能，还能对边缘性供体器官（marginal organs）进行修复调理。诸如设备购置成本高昂、跨医院转运设备难度较大，以及需配备经专业培训的操作人员这类顾虑，均需结合提升移植数量、提高供体器官利用率的潜在收益进行综合权衡。唯有通过审慎遴选供体、掌握适配的技术与科学知识，实现该资源的优化配置，方可保障此项技术得到有效且成功的推广应用。