肝移植供体保存技术及进展
Donor Preservation Technology and Progress of Liver Transplantation

目的：肝移植是终末期肝病和肝恶性肿瘤的最终选择。肝移植技术得到了显著改善，但移植后并发症仍不可避免。移植供体的保存是肝移植的基础，随着器官供需矛盾的日益加剧，边缘化、脂肪变性和心脏循环死亡的供体增加，我们迫切需要更有效、更低成本的保存技术来延长供体缺血时间。本研究介绍了几种经典保存技术的发展过程、几种新的保存方案的进展以及几种保存方案之间的差异，旨在探索更合适的保存技术来指导临床实践，减少资源浪费。方法：通过PubMed、维普、中国知网、万方、重庆医科大学图书馆数据库进行了系统文献检索(1960~2022)，纳入UW液、HTK液、Celsior液、HTK-N、IGL-1液、Polysol液、SCOT液、CZ-1液等或比较两种或多种保存液的文章。结果：共有387篇论文关于UW液、HTK液95篇，Celsior液46篇，HTK-N液12篇，IGL-1液45篇，Polysol液8篇，SCOT液20篇，CZ-1液2篇和102篇HMP和74篇多种保存技术的比较研究。目前临床应用较多的的有HTK液、UW液和Celsior液，两者之间的差异较小，但对肝脏的缺血–再灌注损伤仍然存在。新型溶液有HTK-N、IGI-L液、Polysol液、SCOT液、CZ-1液等。HMP作为最新动态保存方式，也逐渐应用于临床。几种保存技术各有优缺点。结论：已用于临床的HTK液、UW液和Celsior液之间差异性较小，IGL-I液除UW液和Celsior的优点外，还减少高钾血症和钙离子超载的发生，具有更好的器官冲洗效果，更好地减少缺血再灌注损伤。其他技术在动物实验和临床试验中逐渐显示出其优势。HMP作为最新的动态保存模式，可降低肝细胞和内皮细胞损伤。然而，目前理论上有效的保存方案仍处于实验阶段，存在许多不确定性，因此需要更深入的探索。
Background: Liver transplantation is the final choice for end-stage liver disease and liver malignan-cies. At present, liver transplantation technology has been significantly improved, but post- trans-plant complications are still inevitable. The preservation of transplanted donors is the basis of or-gan transplantation techniques and the quality of donor preservation is one of the most important factors affecting the outcome of liver transplantation. With the increasingly imbalance between or-gan supply and demand, the increasing supply liver of marginalization, fatty degeneration and more cardiac circulation death donor, we desperately need more effective, low-cost preservation techniques to prolonged donor ischemia time. The development process of several classical preser-vation techniques, the advance of several new preservation solutions and the differences between several solutions are introduced in this study and which aims to explore more appropriate preser-vation techniques to guide clinical practice and reduce resource waste. Methods: PubMed, VIP, CNKI, Wanfang, Embase and Chongqing Medical University library databases were utilized. Articles from 1960 to 2022 which contain the controduction of UWs, HTKs, Celsior solution, HTK-N solution, IGL-1 solution, Polysol solution, SCOT solution, and CZ-1 solution or comparing graft outcomes between two or more different perfusion/preservation solutions were included. Results: There are 387 pa-pers about UW solution, 95 papers about HTK solution, 46 papers about Celsior solution, 12 papers about HTK-N solution, 45 papers about IGL-1 solution, 8 papers about Polysol solution, 20 papers about SCOT solution, 2 papers about CZ-1 solution and 102 papers about HMP and 74 of them are comparative studies about multiple preservation techniques. At present,