Risbey Charles W G, Pulitano Carlo
Department of Surgery, Royal Prince Alfred Hospital, Sydney 2050, Australia.
Centre for Organ Assessment, Repair & Optimization (COARO), Sydney 2050, Australia.
J Clin Med. 2023 May 28;12(11):3718. doi: 10.3390/jcm12113718.
Liver transplantation is a lifesaving procedure for patients with end-stage liver disease (ESLD). However, many patients never receive a transplant due to insufficient donor supply. Historically, organs have been preserved using static cold storage (SCS). However, recently, ex vivo normothermic machine perfusion (NMP) has emerged as an alternative technique. This paper aims to investigate the clinical progress of NMP in humans.
Papers evaluating the clinical outcomes of NMP for liver transplantation in humans were included. Lab-based studies, case reports, and papers utilizing animal models were excluded. Literature searches of MEDLINE and SCOPUS were conducted. The revised Cochrane risk-of-bias tool for randomised trials (RoB 2) and the risk of bias in nonrandomised studies for interventions (ROBINS-I) tools were used. Due to the heterogeneity of the included papers, a meta-analysis was unable to be completed.
In total, 606 records were identified, with 25 meeting the inclusion criteria; 16 papers evaluated early allograft dysfunction (EAD) with some evidence for lower rates using NMP compared to SCS; 19 papers evaluated patient or graft survival, with no evidence to suggest superior outcomes with either NMP or SCS; 10 papers evaluated utilization of marginal and donor after circulatory death (DCD) grafts, with good evidence to suggest NMP is superior to SCS.
There is good evidence to suggest that NMP is safe and that it likely affords clinical advantages to SCS. The weight of evidence supporting NMP is growing, and this review found the strongest evidence in support of NMP to be its capacity to increase the utilization rates of marginal and DCD allografts.
肝移植是终末期肝病（ESLD）患者的救命手术。然而，由于供体供应不足，许多患者从未接受过移植。从历史上看，器官一直采用静态冷藏（SCS）保存。然而，最近，体外常温机器灌注（NMP）已成为一种替代技术。本文旨在研究NMP在人体中的临床进展。
纳入评估NMP用于人体肝移植临床结果的论文。排除基于实验室的研究、病例报告和使用动物模型的论文。对MEDLINE和SCOPUS进行文献检索。使用修订后的随机试验偏倚风险工具（RoB 2）和非随机干预研究中的偏倚风险（ROBINS-I）工具。由于纳入论文的异质性，无法完成荟萃分析。
共识别出606条记录，其中25条符合纳入标准；16篇论文评估了早期移植肝功能障碍（EAD），有一些证据表明与SCS相比，NMP的发生率较低；19篇论文评估了患者或移植物的存活率，没有证据表明NMP或SCS有更好的结果；10篇论文评估了边缘供体和循环死亡后供体（DCD）移植物的利用率，有充分证据表明NMP优于SCS。
有充分证据表明NMP是安全的，并且可能比SCS具有临床优势。支持NMP的证据权重正在增加，本综述发现支持NMP的最有力证据是其提高边缘供体和DCD移植物利用率的能力。
