Jakubauskas Matas, Jakubauskiene Lina, Leber Bettina, Strupas Kestutis, Stiegler Philipp, Schemmer Peter
General, Visceral and Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria.
Faculty of Medicine, Vilnius University, Vilnius, Lithuania.
Visc Med. 2022 Aug;38(4):243-254. doi: 10.1159/000519788. Epub 2021 Nov 8.
Liver transplantation (LTx) is the only treatment option for patients with end-stage liver disease. Novel organ preservation techniques such as hypothermic machine perfusion (HMP) or normothermic machine perfusion (NMP) are under investigation in order to improve organ quality from extended criteria donors and donors after circulatory death. The aim of this study was to systematically review the literature reporting LTx outcomes using NMP or HMP compared to static cold storage (SCS).
The following data were retrieved: graft primary nonfunction rate, early allograft dysfunction (EAD) rate, biliary complication rate, and 12-month graft and patient survival. A total of 15 studies were included (6 NMP and 9 HMP studies), and meta-analysis was performed only for HMP studies because NMP had considerable differences.
The systematic review showed the potential of NMP to reduce graft injury and lower the liver graft discard rate. The performed quantitative analyses showed that the use of HMP reduces the rate of EAD (odds ratio [OR] 0.51; 95% confidence interval [CI] 0.34-0.76; = 0.001; = 0%) and non-anastomotic biliary strictures (OR 0.34; 95% CI 0.17-0.67; = 0.002; = 0%) compared to SCS.
Our systematic review and meta-analysis revealed that the use of HMP reduces the rate of EAD and non-anastomotic biliary strictures compared to SCS.
肝移植（LTx）是终末期肝病患者的唯一治疗选择。为了提高边缘供体和循环死亡后供体的器官质量，新型器官保存技术如低温机器灌注（HMP）或常温机器灌注（NMP）正在研究中。本研究的目的是系统回顾与静态冷藏（SCS）相比，使用NMP或HMP进行肝移植的文献报道结果。
检索以下数据：移植物原发性无功能率、早期移植物功能障碍（EAD）率、胆道并发症发生率以及12个月移植物和患者生存率。共纳入15项研究（6项NMP研究和9项HMP研究），由于NMP存在显著差异，仅对HMP研究进行了荟萃分析。
系统评价显示NMP有降低移植物损伤和降低肝移植物丢弃率的潜力。进行的定量分析表明，与SCS相比，使用HMP可降低EAD率（优势比[OR]0.51；95%置信区间[CI]0.34 - 0.76；P = 0.001；I² = 0%）和非吻合口胆管狭窄率（OR 0.34；95% CI 0.17 - 0.67；P = 0.002；I² = 0%）。
我们的系统评价和荟萃分析表明，与SCS相比，使用HMP可降低EAD率和非吻合口胆管狭窄率。
