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Moderne Konzepte zur dynamischen Konservierung von Leber und Nieren im Rahmen einer Transplantation

Modern concepts for the dynamic preservation of the liver and kidneys in the context of transplantation

  • Schwerpunkt: Transplantationspathologie
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Zusammenfassung

Der steigende Organmangel führte zu einem Wandel in der experimentellen Erforschung von Organkonservierungsstrategien in der Transplantationsmedizin. Die einfache kalte Lagerung der Transplantate als Standardkonservierungsverfahren bietet für Spenderorgane mit erweiterten Kriterien nicht immer optimale Bedingungen. Als klassische dynamische Konservierungsmethode gilt die hypotherme oxygenierte Maschinenperfusion (HMP). Durch die HMP wird das Gewebe mit Sauerstoff und Nährstoffen versorgt und eine metabolische Erholung des Transplantats vor Implantation ermöglicht. Ein moderneres Konzept ist die normotherme Maschinenperfusion (NMP), die durch Simulation physiologischer Konditionen eine Evaluation und Behandlung des Organs vor Transplantation ermöglicht. Studien zur NMP zeigten allerdings, dass eine vorgeschaltete Periode kalter Lagerung den funktionellen Vorteil der NMP abschwächt. Das kontrolliert oxygenierte Wiedererwärmen (COR) ist eine Strategie, diesen Nachteil ausgleichen, indem das kalt gelagerte Transplantat langsam und schrittweise auf subnormotherme oder normotherme Temperaturen erwärmt wird. So kann eine schonende Adaptation des Energiestoffwechsels stattfinden und dem Wiedererwärmungsschaden vorgebeugt werden.

Abstract

The increasing demand on donor grafts has forced experimental research on transplantation medicine to develop more efficient organ preservation strategies. Simple cold storage of grafts rarely offers optimal conditions for extended criteria donor organs. Hypothermic, oxygenated machine perfusion (HMP) is a classical method of dynamic organ preservation, which enables the provision of oxygen and nutrients to the tissue and provides a metabolic recovery of the graft prior to implantation. A more modern approach is normothermic machine perfusion (NMP), which instead simulates physiological conditions and enables an ex vivo evaluation and treatment of organ grafts. However, studies have found that a preceding period of cold storage significantly mitigates the functional advantage of NMP. A strategy to circumvent this phenomenon is controlled oxygenated rewarming (COR). The cold-stored graft is slowly and gradually rewarmed to subnormothermic or normothermic temperatures, providing a gentle adaption of energy metabolism and counteracting events of rewarming injury.

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Abbreviations

ATP:

Adenosintriphosphat

BES:

N,N-Bis-(2-hydroxyethyl)-2-aminoethansulfonsäure

COR:

„Controlled oxygenated rewarming“ (kontrollierte oxygenierte Wiedererwärmung)

CS:

„Cold storage“ (kalte Lagerung)

DCD:

„Donation after cardiac death“ (Spende nach Herztod)

ECD:

„Expanded criteria donor“ (Spender mit erweiterten Kriterien)

HMP:

Hypotherme Maschinenperfusion

HTK:

Histidin-Tryptophan-Ketoglutarat

KLF2:

Krüppel-like factor 2

mtHSP:

Mitochondriales Hitzeschockprotein

NAD:

Nicotinamidadenindinukleotid

NMP:

Normotherme Maschinenperfusion

RI:

„Rewarming injury“ (Wiedererwärmungsschaden)

UW:

University of Wisconsin

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Danksagung

Die Autoren bedanken sich für die wertvolle Hilfe von B. Lüer für das Korrekturlesen des Manuskripts.

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  1. Abteilung für chirurgische Forschung, Klinik für Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45147, Essen, Deutschland

    C. von Horn & T. Minor

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Correspondence to C. von Horn.

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C. von Horn und T. Minor geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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K. W. Schmid, Essen

H. A. Baba, Essen

H.-U. Schildhaus, Essen

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von Horn, C., Minor, T. Moderne Konzepte zur dynamischen Konservierung von Leber und Nieren im Rahmen einer Transplantation. Pathologe 40, 292–298 (2019). https://doi.org/10.1007/s00292-019-0595-2

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