Normothermic Acellular Ex Vivo Liver Perfusion (NEVLP) Reduces Liver and Bile Duct in DCD Liver Grafts
Notice bibliographique
Résumé
To the Editor: We welcome the comments from Martins (1Martins PNA. Normothermic machine preservation as an approach to decrease biliary complications of DCD liver grafts.Am J Transplant. 2013; 13: 3287-3288Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar) and op den Dries et al (2op den Dries S Karimian N Weeder PD Porte RJ. Normothermic acellular machine perfusion and bile duct injury in pig livers retrieved after cardiac death.Am J Transplant. 2013; 13: 3289Abstract Full Text Full Text PDF PubMed Scopus (8) Google Scholar) and the opportunity to further discuss our results. It is important to develop a large animal model that closely resembles ischemic type biliary stricture (ITBS) in donation after cardiac death (DCD) grafts. The studies by Brunner et al (3Brunner SM Junger H Ruemmele P et al.Bile duct damage after cold storage of deceased donor livers predicts biliary complications after liver transplantation.J Hepatol. 2013; 58: 1133-1139Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar) and Hansen et al (4Hansen T Hollemann D Pitton MB et al.Histological examination and evaluation of donor bile ducts received during orthotopic liver transplantation—A morphological clue to ischemic-type biliary lesion?.Virchows Archiv. 2012; 461: 41-48Crossref PubMed Scopus (84) Google Scholar) investigated common bile duct biopsies in humans after cold storage and reperfusion. In both studies, the biopsies were taken from the most distal part of the common bile duct, which is usually not used for the anastomosis. Common bile duct biopsies are susceptible to changes that are independent from ITBS in the setting of DCD organ retrieval. Distal common bile duct biopsies might include tissue that has been devascularized during organ retrieval, has been mechanically manipulated during portal dissection or bile duct catheterization. In addition, ITBS more often affects intrahepatic bile ducts than the extrahepatic biliary system and common bile duct biopsies might not be representative for ITBS. In our study, only intrahepatic bile ducts were used for histologic evaluation, which we believe better reflects the ITBS. In our study, bile flow was not a marker of bile function. Bilirubin concentration in the bile better reflected bile duct injury. It is possible that injured biliary mucosa secretes serum-like fluid, which falsely increases the bile volume. In addition, during ex vivo reperfusion, bile flow might be changed in all groups because of the lack of hormonal or neurogen stimulation, and nonphysiologic levels of bile precursors. Oxygen extraction during ex vivo perfusion was calculated using the oxygen content of the perfusate at the inflow and at the outflow, multiplied by the flow (reverse Fick method; VO2 = Q[CaO2 − CvO2]). We used Kelman’s equation (5Kelman GR. Digital computer subroutine for the conversion of oxygen tension into saturation.J Appl Physiol. 1966; 21: 1375-1376Crossref PubMed Scopus (386) Google Scholar) to calculate hemoglobin saturation of the blood perfusate at the corresponding PO2. Since pigs of comparable size were used in all groups, we did not present the data as per gram liver weight. The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,004 | 0,019 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,001 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,002 | 0,002 |
| Science ouverte | 0,002 | 0,001 |
| Intégrité de la recherche | 0,006 | 0,007 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,006 | 0,003 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».