低温机器灌注可降低人肝移植后早期移植物功能障碍和胆道并发症的发生率，并提高1年移植物存活率：一项荟萃分析。
Hypothermic machine perfusion reduces the incidences of early allograft dysfunction and biliary complications and improves 1-year graft survival after human liver transplantation: A meta-analysis.
作者信息
Zhang Yili, Zhang Yangmin, Zhang Mei, Ma Zhenhua, Wu Shengli
机构信息
Department of Medical Imaging, The First Affiliated Hospital of Xi'an Jiaotong University.
Department of Blood Transfusion, Xi'an Central Hospital.
出版信息
Medicine (Baltimore). 2019 Jun;98(23):e16033. doi: 10.1097/MD.0000000000016033.
BACKGROUND
The worldwide organ shortage continues to be the main limitation of liver transplantation. To bridge the gap between the demand and supply of liver grafts, it becomes necessary to use extended criteria donor livers for transplantation. Hypothermic machine perfusion (HMP) is designed to improve the quality of preserved organs before implantation. In clinical liver transplantation, HMP is still in its infancy.
METHODS
A systematic search of the PubMed, EMBASE, Springer, and Cochrane Library databases was performed to identify studies comparing the outcomes in patients with HMP versus static cold storage (SCS) of liver grafts. The parameters analyzed included the incidences of primary nonfunction (PNF), early allograft dysfunction (EAD), vascular complications, biliary complications, length of hospital stay, and 1-year graft survival.
RESULTS
A total of 6 studies qualified for the review, involving 144 and 178 liver grafts with HMP or SCS preservation, respectively. The incidences of EAD and biliary complications were significantly reduced with an odds ratio (OR) of 0.36 (95% confidence interval [CI] 0.17-0.77, P = .008) and 0.47 (95% CI 0.28-0.76, P = .003), respectively, and 1-year graft survival was significantly increased with an OR of 2.19 (95% CI 1.14-4.20, P = .02) in HMP preservation compared to SCS. However, there was no difference in the incidence of PNF (OR 0.30, 95% CI 0.06-1.47, P = .14), vascular complications (OR 0.69, 95% CI 0.29-1.66, P = .41), and the length of hospital stay (mean difference -0.30, 95% CI -4.10 to 3.50, P = .88) between HMP and SCS preservation.
CONCLUSIONS
HMP was associated with a reduced incidence of EAD and biliary complications, as well as an increased 1-year graft survival, but it was not associated with the incidence of PNF, vascular complications, and the length of hospital stay.
背景
全球范围内的器官短缺仍然是肝移植的主要限制因素。为了弥合肝移植供体供需之间的差距，使用扩大标准供体肝脏进行移植变得必要。低温机器灌注（HMP）旨在改善植入前保存器官的质量。在临床肝移植中，HMP仍处于起步阶段。
方法
对PubMed、EMBASE、Springer和Cochrane图书馆数据库进行系统检索，以确定比较肝移植采用HMP与静态冷藏（SCS）患者结局的研究。分析的参数包括原发性无功能（PNF）、早期移植物功能障碍（EAD）、血管并发症、胆道并发症、住院时间和1年移植物存活率。
结果
共有6项研究符合综述要求，分别涉及144例采用HMP保存和178例采用SCS保存的肝移植。与SCS相比，HMP保存时EAD和胆道并发症的发生率显著降低，优势比（OR）分别为0.36（95%置信区间[CI]0.17 - 0.77，P = 0.008）和0.47（95%CI 0.28 - 0.76，P = 0.003），1年移植物存活率显著提高，OR为2.19（95%CI 1.14 - 4.20，P = 0.02）。然而，PNF发生率（OR 0.30，95%CI 0.06 - 1.47，P = 0.14）、血管并发症发生率（OR 0.69，95%CI 0.29 - 1.66，P = 0.41）以及HMP与SCS保存之间的住院时间（平均差异 -0.30，95%CI -4.10至3.50，P = 0.88）无差异。
结论
HMP与EAD和胆道并发症发生率降低以及1年移植物存活率提高相关，但与PNF发生率、血管并发症和住院时间无关。
Zotero 插件