Garzali Ibrahim Umar, Aloun Ali, Abuzeid Ez El Din, Sheshe Abdurrahman Abba
Department of Surgery, Aminu Kano Teaching Hospital, Kano, Nigeria.
Department of Surgery, King Hussein Medical Centre, Amman, Jordan.
Hepatol Forum. 2024 Mar 22;5(4):211-216. doi: 10.14744/hf.2023.2023.0069. eCollection 2024.
The use of marginal grafts is very challenging and is associated with post-reperfusion syndrome and early allograft dysfunction. The outcomes of machine perfusion for the preservation of marginal grafts have been compared with that of static cold storage, with studies reporting a reduced risk of ischemic cholangiopathy and graft loss. We performed this systematic review and meta-analysis of randomized controlled trials (RCTs) comparing outcomes of machine perfusion of liver grafts to static cold storage (SCS) of liver grafts during liver transplantation. Two independent researchers thoroughly searched for literature in the following databases: PubMed (Medline), Cochrane Central Register of Controlled Studies (CENTRAL), clinical trial registry, ResearchGate, Google Scholar, and Scopus (ELSEVIER) databases (last search: November 2023). The search terms used were: "dynamic perfusion," "normothermic perfusion," "hypothermic perfusion," "liver transplantation," "static cold storage," "NMP," "HOPE," "extended criteria grafts," "marginal grafts," "RCTs," "randomized controlled trials," "warm ischemia," and "cold ischemia." Eight RCTs published between 2019 and 2023 were included in the data synthesis and meta-analysis. The primary outcome considered was the overall incidence of early allograft dysfunction (EAD) between the two methods of graft perfusion after liver transplantation. The secondary outcome considered was the rate of retransplantation. Our meta-analysis revealed that SCS is associated with more EAD when compared with machine perfusion, with a p-value of <0.00001. We also found that the rate of retransplantation is higher among patients who received a liver preserved by SCS, with a p-value of 0.02. The use of machine perfusion in the preservation of liver grafts showed a significant reduction in early allograft dysfunction and retransplantation.
边缘供肝的使用极具挑战性，且与再灌注综合征及早期移植物功能障碍相关。已将用于保存边缘供肝的机器灌注结果与静态冷藏的结果进行了比较，研究报告显示缺血性胆管病和移植物丢失风险降低。我们对随机对照试验（RCT）进行了这项系统评价和荟萃分析，比较肝移植期间肝移植物机器灌注与静态冷藏（SCS）的结果。两名独立研究人员在以下数据库中全面检索文献：PubMed（Medline）、Cochrane对照研究中心注册库（CENTRAL）、临床试验注册库、ResearchGate、谷歌学术和Scopus（爱思唯尔）数据库（最后检索时间：2023年11月）。使用的检索词为：“动态灌注”“常温灌注”“低温灌注”“肝移植”“静态冷藏”“NMP”“HOPE”“扩展标准供肝”“边缘供肝”“RCT”“随机对照试验”“热缺血”和“冷缺血”。2019年至2023年发表的8项RCT纳入了数据合成和荟萃分析。所考虑的主要结局是肝移植后两种移植物灌注方法之间早期移植物功能障碍（EAD）的总体发生率。所考虑的次要结局是再次移植率。我们的荟萃分析显示，与机器灌注相比，SCS与更多的EAD相关，p值<0.00001。我们还发现，接受SCS保存肝脏的患者再次移植率更高，p值为0.02。在肝移植物保存中使用机器灌注显示早期移植物功能障碍和再次移植显著减少。
