*Centre for Evidence in Transplantation, Royal College of Surgeons of England and London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom; and †Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.
Ann Surg. 2014 Jul;260(1):46-55. doi: 10.1097/SLA.0000000000000402.
The objective of this review was to systematically evaluate the evidence comparing preservation fluids for liver allografts on transplant outcomes.
Adequate preservation of liver allografts for transplantation is essential for successful transplant outcomes. There are several preservation fluids available that have been specifically designed for the static cold storage of livers. These fluids differ in composition and cost.
literature search was performed using MEDLINE, EMBASE, Cochrane Library, Transplant Library, and the International Clinical Trials Registry Platform. Only randomized controlled trials were included. Studies were assessed for methodological quality. Primary outcomes were the risk of early dysfunction, primary nonfunction, retransplantation, patient survival, and graft survival. Secondary outcomes were serum biochemical parameters in the first week and biliary complications. Summary effects were calculated as relative risk and relative log survival with 95% confidence intervals (95% CIs).
Sixteen randomized controlled trials met the full inclusion criteria (1619 livers). There is good evidence that the University of Wisconsin and Celsior solutions are associated with the same rates of early dysfunction (relative risk = 1.08, 95% CI = 0.63-1.86, P = 0.77), primary nonfunction (relative risk = 0.73, 95% CI = 0.22-2.40, P = 0.60), patient survival (relative log survival = 0.86, 95% CI = 0.58-1.28, P = 0.46), and graft survival (relative log survival = 0.85, 95% CI = 0.59-1.23, P = 0.39). There was no good evidence of any difference in outcomes when comparing histidine-tryptophan-ketoglutarate with either of the University of Wisconsin or Celsior solution, although data were limited.
Data from included studies suggest that preservation of deceased donor livers with the University of Wisconsin or Celsior solution results in equivalent outcomes.
本综述的目的是系统评估比较肝移植供体保存液对移植结局的证据。
肝移植供体的充分保存对于成功的移植结局至关重要。有几种专门设计用于肝脏静态冷藏的保存液。这些液体在组成和成本上有所不同。
使用 MEDLINE、EMBASE、Cochrane 图书馆、移植图书馆和国际临床试验注册平台进行文献检索。仅纳入随机对照试验。对研究进行方法学质量评估。主要结局是早期功能障碍、原发性无功能、再次移植、患者存活率和移植物存活率的风险。次要结局是第一周的血清生化参数和胆道并发症。汇总效应以相对风险和相对对数存活率（95%置信区间[95%CI]）表示。
16 项随机对照试验符合全部纳入标准（1619 个肝脏）。有充分证据表明威斯康星大学和 Celsior 溶液在早期功能障碍（相对风险=1.08，95%CI=0.63-1.86，P=0.77）、原发性无功能（相对风险=0.73，95%CI=0.22-2.40，P=0.60）、患者存活率（相对对数存活率=0.86，95%CI=0.58-1.28，P=0.46）和移植物存活率（相对对数存活率=0.85，95%CI=0.59-1.23，P=0.39）方面具有相同的发生率。虽然数据有限，但比较组氨酸-色氨酸-酮戊二酸与威斯康星大学或 Celsior 溶液时，没有充分证据表明结果存在差异。
纳入研究的数据表明，使用威斯康星大学或 Celsior 溶液保存脑死亡供体肝脏可产生等效的结果。
