Research press release





今回、David Nasrallaたちの研究グループは、220人の肝移植患者を対象として、従来の低温保存と常温機械潅流を比較する無作為化試験を行った。Nasrallaたちは、肝損傷のバイオマーカーを測定し、常温潅流を行った場合には、低温保存と比べて、肝臓の平均保存期間が54%延長し、移植肝障害が50%減少し、肝臓の廃棄率が50%低下したことを明らかにした。また、移植後の1年間における両者の比較では、胆管合併症の発生率、および臨床的に認められたバイオマーカーによって予測される移植肝と患者の生存率のいずれにも、有意差が認められなかった。

同時掲載のStefan SchneebergerのNews & Viewsには、「正常な状態に近い状態で臓器を保存できれば、肝移植だけでなく、肝臓の手術や臓器の管理の点でも進歩をもたらす手段になり得る」と記されている。

Preserving livers at body temperature may improve transplant outcomes and increase viable donor liver numbers, thereby lowering waiting list mortality rates, reports a paper published online this week in Nature.

Rising liver disease rates have rendered the supply of viable donor organs inadequate. Many potential donor livers are deemed too high risk, being more susceptible to damage during the refrigeration used to preserve organs mid-transplant. Liver viability cannot be gauged during cold storage, as normal cellular activity is suppressed. A promising alternative lies in maintaining donor livers at body temperature, supplying the organs with oxygenated blood, medications and nutrients - much like a patient on life support - through a process called normothermic machine perfusion. Livers can be kept in this manner for 24 hours, and the process could one day enable the monitoring of viability along with treatment and repair as needed.

David Nasralla and colleagues conduct the first randomized trial comparing conventional cold storage with normothermic machine perfusion in 220 liver transplant patients. Measuring biomarkers of liver damage, they found a 50% reduction in graft injury in normothermic preservation compared with cold storage, despite a 54% increase in the mean duration over which livers were preserved and a 50% lower rate of organ discard. In addition, in the year after transplant, the authors found no significant differences in rates of bile duct complication, or graft and patient survival rates (as predicted by a clinically accepted biomarker), between preservation approaches.

"The ability to preserve an organ under close-to-normal conditions could be instrumental in advancing not only liver transplantation, but also liver surgery and organ care," writes Stefan Schneeberger in an accompanying News & Views article.

doi: 10.1038/s41586-018-0047-9

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