Transplantation Center, Digestive Disease and Surgery Institute, Cleveland Clinic, Cleveland, Ohio.
University of Milan, Università degli Studi di Milano, Milan, Italy.
Hepatology. 2023 Sep 1;78(3):835-846. doi: 10.1097/HEP.0000000000000363. Epub 2023 Mar 30.
Acute cellular rejection (ACR) is a frequent complication after liver transplantation. By reducing ischemia and graft damage, dynamic preservation techniques may diminish ACR. We performed a systematic review to assess the effect of currently tested organ perfusion (OP) approaches versus static cold storage (SCS) on post-transplant ACR-rates.
A systematic search of Medline, Embase, Cochrane Library, and Web of Science was conducted. Studies reporting ACR-rates between OP and SCS and comprising at least 10 liver transplants performed with either hypothermic oxygenated perfusion (HOPE), normothermic machine perfusion, or normothermic regional perfusion were included. Studies with mixed perfusion approaches were excluded. Eight studies were identified (226 patients in OP and 330 in SCS). Six studies were on HOPE, one on normothermic machine perfusion, and one on normothermic regional perfusion. At meta-analysis, OP was associated with a reduction in ACR compared with SCS [OR: 0.55 (95% CI, 0.33-0.91), p =0.02]. This effect remained significant when considering HOPE alone [OR: 0.54 (95% CI, 0.29-1), p =0.05], in a subgroup analysis of studies including only grafts from donation after cardiac death [OR: 0.43 (0.20-0.91) p =0.03], and in HOPE studies with only donation after cardiac death grafts [OR: 0.37 (0.14-1), p =0.05].
Dynamic OP techniques are associated with a reduction in ACR after liver transplantation compared with SCS. PROSPERO registration: CRD42022348356.
急性细胞排斥（ACR）是肝移植后的常见并发症。通过减少缺血和移植物损伤，动态保存技术可能会降低 ACR。我们进行了一项系统评价，以评估目前测试的器官灌注（OP）方法与静态冷保存（SCS）对移植后 ACR 发生率的影响。
对 Medline、Embase、Cochrane 图书馆和 Web of Science 进行了系统搜索。报告 OP 和 SCS 之间 ACR 发生率的研究，并且至少有 10 例肝移植采用低温充氧灌注（HOPE）、常温机器灌注或常温区域灌注进行，包含在本研究中。混合灌注方法的研究被排除在外。确定了 8 项研究（OP 组 226 例，SCS 组 330 例）。6 项研究为 HOPE，1 项为常温机器灌注，1 项为常温区域灌注。荟萃分析显示，与 SCS 相比，OP 降低了 ACR 的发生率[OR：0.55（95%CI，0.33-0.91），p=0.02]。当仅考虑 HOPE 时，这种效果仍然显著[OR：0.54（95%CI，0.29-1），p=0.05]，在仅包含心脏死亡后捐献供体的研究的亚组分析中[OR：0.43（0.20-0.91），p=0.03]，以及仅包含心脏死亡后捐献供体的 HOPE 研究中[OR：0.37（0.14-1），p=0.05]。
与 SCS 相比，动态 OP 技术可降低肝移植后 ACR 的发生率。PROSPERO 注册号：CRD42022348356。
