J Hepatol. 2023 Jun 9:S0168-8278(23)00399-9. doi: 10.1016/j.jhep.2023.05.027. Online ahead of print.
ABSTRACT
BACKGROUND & AIMS: Machine perfusion is increasingly tested in clinical transplantation. Despite this success, the number of large prospective clinical trials remains limited. The aim of this study is therefore to compare the impact of machine perfusion on outcomes after liver transplantation versus static cold storage (SCS).
METHODS: A systematic search of MEDLINE, EMBASE, CINAHL and the Cochrane Central Register of Controlled Trials (CENTRAL) was conducted to identify randomized controlled trials (RCTs) reporting “posttransplant” outcomes of machine perfused livers compared to SCS. Data were pooled using random effect models. Risk ratios (RR) were calculated for relevant outcomes. The quality of evidence was rated using the GRADE-framework. PROSPERO-registration: CRD42022355252.
RESULTS: Seven RCTs were identified with hypothermic oxygenated (HOPE, n=4) and normothermic machine perfusion (NMP, n=3), including a total number of 1017 patients. Both techniques were associated with significantly lower rates of early allograft dysfunction (NMP: n=41/282; SCS: n=74/253; RR:0.50, 95%CI:0.30-0.86, p=0.01, I2:39%; HOPE: n=45/241; SCS: n=97/241, RR:0.48, 95%CI:0.35-0.65, p<0.00001, I2:5%). The HOPE-approach led to a significant reduction of major complications (Clavien Grade ≥IIIb; HOPE: n=90/241; SCS: n=117/241, RR: 0.76, 95%CI: 0.63-0.93, p=0.006, I2:0%), “retransplantation” (HOPE: n=1/163; SCS: n=11/163; RR:0.21, 95%CI: 0.04-0.96, p=0.04; I2:0%) and graft loss (HOPE: n=7/163; SCS: n=19/163; RR:0.40, 95%CI: 0.17-0.95, p=0.04; I2:0%). Both perfusion techniques were found to likely reduce overall biliary complications and non-anastomotic strictures.
CONCLUSIONS: Although this study provides the highest current evidence on the role of machine perfusion, outcomes remain limited to a one-year follow-up after liver transplantation. Comparative RCTs and large real world cohort studies with longer follow-up are required to enhance the robustness of the data further, thereby supporting the introduction of perfusion technologies in routine clinical practice.
PMID:37302578 | DOI:10.1016/j.jhep.2023.05.027
