Dataset Information

Effects of machine perfusion strategies on different donor types in liver transplantation: a systematic review and meta-analysis.

ABSTRACT:

Background

Increasing use of extended-criteria donors (ECD) set higher requirements for graft preservation. Machine perfusion (MP) improves orthotopic liver transplantation (OLT) outcomes but its effects on different donor types remains unclear. Our aim was to assess the effects of hypothermic machine perfusion (HMP), normothermic machine perfusion (NMP), or normothermic regional perfusion (NRP) versus static cold storage (SCS) on different donor types.

Materials and methods

A literature search comparing the efficacy of MP versus SCS in PubMed, Cochrane and EMBASE database was conducted. Meta-analysis was performed to obtain pooled effects of MP on extended criteria donors (ECD), donation after circulatory death (DCD), donor after brainstem death.

Results

39 studies were included (9 RCTs and 30 cohort studies). Compared with SCS, HMP significantly reduced the risk of non-anastomotic biliary stricture (NAS) (OR 0.43, 95%CI 0.26-0.72), major complications (OR 0.55, 95%CI 0.39-0.78), early allograft dysfunction (EAD) (OR 0.46, 95%CI 0.32-0.65) and improve one-year graft (OR 2.36, 95%CI 1.55-3.62) in ECD-OLT. HMP also reduced primary nonfunction (PNF) (OR 0.40, 95%CI 0.18-0.92) and acute rejection (OR 0.62, 95%CI 0.40-0.97). NMP only reduced major complications in ECD-OLT (OR 0.56, 95%CI 0.34-0.94), without favorable effects on other complications and survival. NRP lower the overall risk of NAS (OR 0.27, 95%CI 0.11-0.68), PNF (OR 0.43, 95%CI 0.22-0.85), EAD (OR 0.58, 95%CI 0.42-0.80) and meanwhile improved one-year graft survival (OR 2.40, 95%CI 1.65-3.49) in control DCD-OLT.

Conclusions

HMP might currently be considered for marginal livers as it comprehensively improves ECD-OLT outcomes. NMP assists some outcomes in ECD-OLT but more evidence regarding NMP-ECD is warrant. NRP significantly improves DCD-OLT outcomes and is recommended where longer non-touch periods exist.

SUBMITTER: Liang A

PROVIDER: S-EPMC10651255 | biostudies-literature | 2023 Aug

REPOSITORIES: biostudies-literature

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Publications

Effects of machine perfusion strategies on different donor types in liver transplantation: a systematic review and meta-analysis.

Liang Aijun A Cheng Weiye W Cao Peihua P Cai Shaoru S Zhang Linya L Zhong Kebo K Nie Yu Y

International journal of surgery (London, England) 20231101 11

<h4>Background</h4>The increasing use of extended criteria donors (ECD) sets higher requirements for graft preservation. Machine perfusion (MP) improves orthotopic liver transplantation (OLT) outcomes, but its effects on different donor types remains unclear. The authors' aim was to assess the effects of hypothermic machine perfusion (HMP), normothermic machine perfusion (NMP), or normothermic regional perfusion (NRP) versus static cold storage (SCS) on different donor types.<h4>Materials and me ...[more]

PMID: 37578436

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Project description:The two main options for renal allograft preservation are static cold storage (CS) and machine perfusion (MP). There has been considerably increased interest in MP preservation of kidneys, however conflicting evidence regarding its efficacy and associated costs have impacted its scale of clinical uptake. Additionally, there is no clear consensus regarding oxygenation, and hypo- or normothermia, in conjunction with MP, and its mechanisms of action are also debated. The primary aims of this article were to elucidate the benefits of MP preservation with and without oxygenation, and/or under normothermic conditions, when compared with CS prior to deceased donor kidney transplantation.Clinical (observational studies and prospective trials) and animal (experimental) articles exploring the use of renal MP were assessed (EMBASE, Medline, and Cochrane databases). Meta-analyses were conducted for the comparisons between hypothermic MP (hypothermic machine perfusion [HMP]) and CS (human studies) and normothermic MP (warm (normothermic) perfusion [WP]) compared with CS or HMP (animal studies). The primary outcome was allograft function. Secondary outcomes included graft and patient survival, acute rejection and parameters of tubular, glomerular and endothelial function. Subgroup analyses were conducted in expanded criteria (ECD) and donation after circulatory (DCD) death donors.A total of 101 studies (63 human and 38 animal) were included. There was a lower rate of delayed graft function in recipients with HMP donor grafts compared with CS kidneys (RR 0.77; 95% CI 0.69-0.87). Primary nonfunction (PNF) was reduced in ECD kidneys preserved by HMP (RR 0.28; 95% CI 0.09-0.89). Renal function in animal studies was significantly better in WP kidneys compared with both HMP (standardized mean difference [SMD] of peak creatinine 1.66; 95% CI 3.19 to 0.14) and CS (SMD of peak creatinine 1.72; 95% CI 3.09 to 0.34). MP improves renal preservation through the better maintenance of tubular, glomerular, and endothelial function and integrity.HMP improves short-term outcomes after renal transplantation, with a less clear effect in the longer-term. There is considerable room for modification of the process to assess whether superior outcomes can be achieved through oxygenation, perfusion fluid manipulation, and alteration of perfusion temperature. In particular, correlative experimental (animal) data provides strong support for more clinical trials investigating normothermic MP.

Project description:IntroductionAgeing of the general population has led to an increase in the use of suboptimal kidneys from expanded criteria donation after brain death (ECD-DBD) and donation after circulatory death (DCD) donors. However, these kidneys have inferior graft outcomes and lower rates of immediate function. Normothermic machine perfusion (NMP) may improve outcomes of these suboptimal donor kidneys. Previous non-randomized studies have shown the safety of this technique and suggested its efficacy in improving the proportion of immediate functioning kidneys compared to static cold storage (SCS). However, its additional value to hypothermic machine perfusion (HMP), which has already been proved superior to SCS, has not yet been established.Methods and analysisThis single-center, open-label, randomized controlled trial aims to assess immediate kidney function after 120 minutes additional, end-ischemic NMP compared to HMP alone. Immediate kidney function is defined as no dialysis treatment in the first week after transplant. Eighty recipients on dialysis at the time of transplant who receive an ECD-DBD or DCD kidney graft are eligible for inclusion. In the NMP group, the donor kidney is taken of HMP upon arrival in the recipient hospital and thereafter put on NMP for 120 minutes at 37 degrees Celsius followed by transplantation. In the control group, donor kidneys stay on HMP until transplantation. The primary outcome is immediate kidney function.Ethics and disseminationThe protocol has been approved by the Medical Ethical Committee of Erasmus Medical Center (2020-0366). Results of this study will be submitted to peer-reviewed journals.Registrationregistered in clinicaltrials.gov (NCT04882254).HighlightsThis is the first RCT to compare additional NMP to HMP alone.Extensive sampling will offer in-depth analysis of kidney physiology during NMP.This RCT may help identify biomarkers to predict clinical outcomes during NMP.Biomarkers can help develop NMP as assessment tool for declined kidneys.

Dataset Information

Effects of machine perfusion strategies on different donor types in liver transplantation: a systematic review and meta-analysis.

Background

Materials and methods

Results

Conclusions

Publications

Effects of machine perfusion strategies on different donor types in liver transplantation: a systematic review and meta-analysis.

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