机器灌注策略对不同供体类型在肝移植中的影响：系统评价和荟萃分析。

Effects of machine perfusion strategies on different donor types in liver transplantation: a systematic review and meta-analysis.

机构信息

General Surgery Center, Department of Hepatobiliary Surgery II, Guangdong Provincial Research Center for Artificial Organ and Tissue Engineering, Guangzhou Clinical Research and Transformation Center for Artificial Liver, Institute of Regenerative Medicine, Zhujiang Hospital, Southern Medical University,Guangzhou, Guangdong Province, China.

Clinical Research Center, Zhujiang Hospital.

出版信息

Int J Surg. 2023 Nov 1;109(11):3617-3630. doi: 10.1097/JS9.0000000000000661.

DOI:10.1097/JS9.0000000000000661

PMID:37578436

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10651255/

Abstract

BACKGROUND

The increasing use of extended criteria donors (ECD) sets higher requirements for graft preservation. Machine perfusion (MP) improves orthotopic liver transplantation (OLT) outcomes, but its effects on different donor types remains unclear. The authors' aim was to assess the effects of hypothermic machine perfusion (HMP), normothermic machine perfusion (NMP), or normothermic regional perfusion (NRP) versus static cold storage (SCS) on different donor types.

MATERIALS AND METHODS

A literature search comparing the efficacy of MP versus SCS in PubMed, Cochrane, and EMBASE database was conducted. A meta-analysis was performed to obtain pooled effects of MP on ECD, donation after circulatory death (DCD), and donor after brainstem death.

RESULTS

Thirty nine studies were included (nine randomized controlled trials and 30 cohort studies). Compared with SCS, HMP significantly reduced the risk of non-anastomotic biliary stricture (NAS) [odds ratio (OR) 0.43, 95% confidence interval (CI) 0.26-0.72], major complications (OR 0.55, 95% CI 0.39-0.78), and early allograft dysfunction (EAD) (OR 0.46, 95% CI 0.32-0.65) and improved 1-year graft survival (OR 2.36, 95% CI 1.55-3.62) in ECD-OLT. HMP also reduced primary non-function (PNF) (OR 0.40, 95% CI 0.18-0.92) and acute rejection (OR 0.62, 95% CI 0.40-0.97). NMP only reduced major complications in ECD-OLT (OR 0.56, 95% CI 0.34-0.94), without favorable effects on other complications and survival. NRP lowered the overall risk of NAS (OR 0.27, 95% CI 0.11-0.68), PNF (OR 0.43, 95% CI 0.22-0.85), and EAD (OR 0.58, 95% CI 0.42-0.80) and meanwhile improved 1-year graft survival (OR 2.40, 95% CI 1.65-3.49) in control DCD-OLT.

CONCLUSIONS

HMP might currently be considered for marginal livers as it comprehensively improves ECD-OLT outcomes. NMP assists some outcomes in ECD-OLT, but more evidence regarding NMP-ECD is warranted. NRP significantly improves DCD-OLT outcomes and is recommended where longer non-touch periods exist.

摘要

背景

越来越多的使用扩展标准供体（ECD）对移植物保存提出了更高的要求。机器灌注（MP）改善了原位肝移植（OLT）的结果，但它对不同供体类型的影响仍不清楚。作者的目的是评估低温机器灌注（HMP）、常温机器灌注（NMP）、常温区域灌注（NRP）与静态冷藏（SCS）对不同供体类型的影响。

材料和方法

在 PubMed、Cochrane 和 EMBASE 数据库中进行了比较 MP 与 SCS 疗效的文献检索。进行荟萃分析以获得 MP 对 ECD、循环死亡后捐献（DCD）和脑死亡后捐献的汇总效果。

结果

共纳入 39 项研究（9 项随机对照试验和 30 项队列研究）。与 SCS 相比，HMP 显著降低了非吻合胆道狭窄（NAS）的风险[比值比（OR）0.43，95%置信区间（CI）0.26-0.72]、主要并发症（OR 0.55，95%CI 0.39-0.78）和早期移植物功能障碍（EAD）（OR 0.46，95%CI 0.32-0.65），并提高了 ECD-OLT 的 1 年移植物存活率（OR 2.36，95%CI 1.55-3.62）。HMP 还降低了原发性无功能（PNF）（OR 0.40，95%CI 0.18-0.92）和急性排斥反应（OR 0.62，95%CI 0.40-0.97）的风险。NMP 仅降低了 ECD-OLT 的主要并发症（OR 0.56，95%CI 0.34-0.94），对其他并发症和存活率没有有利影响。NRP 降低了总体 NAS（OR 0.27，95%CI 0.11-0.68）、PNF（OR 0.43，95%CI 0.22-0.85）和 EAD（OR 0.58，95%CI 0.42-0.80）的风险，同时提高了对照 DCD-OLT 的 1 年移植物存活率（OR 2.40，95%CI 1.65-3.49）。