Viana Patricia, Castillo-Flores Samy, Mora Maria M R, Cabral Thamiris D D, Martins Paulo N, Kueht Michael, Faria Isabella
University of Extreme South of Santa Catarina, Criciuma, Brazil.
Universidad Peruana Cayetano Heredia, Lima, Peru.
Artif Organs. 2025 Jun;49(6):945-954. doi: 10.1111/aor.14960. Epub 2025 Jan 30.
Normothermic machine perfusion (NMP) represents an alternative to prolong liver preservation and reduce organ discard rates. We performed an updated systematic review and meta-analysis to compare NMP with static cold storage (SCS) in liver transplantation.
MEDLINE, Embase, and Cochrane were searched for randomized controlled trials (RCTs) or observational studies. Risk ratios (RR) and mean differences were calculated. p < 0.05 was considered significant. A random-effects model was applied for all outcomes.
CRD42023486184.
We included 1295 patients from 5 RCTs and 6 observational studies from 2016 to 2023. 592 (45.7%) underwent NMP. A subgroup RCT analysis favored NMP for non-anastomotic strictures (RR 0.4; 95% CI 0.2, 0.9), postreperfusion syndrome (RR 0.4; 95% CI 0.27, 0.56), and early allograft dysfunction (RR 0.6; 95% CI 0.4, 0.9). NMP favored higher organ utilization rates (RR 1.1; 95% CI 1.02, 1.18). No significant differences between NMP and SCS were observed in graft survival or patient survival at 12 months, primary non-function, serious adverse events, overall biliary complications, AST, or bilirubin levels peak within the first 7 days, ICU or hospital length of stay.
Our findings suggest that NMP is associated with lower non-anastomotic biliary stricture rates, postreperfusion syndrome, early allograft dysfunction, and higher organ utilization in the RCT subgroup analysis, without increasing adverse events.
常温机器灌注（NMP）是延长肝脏保存时间并降低器官丢弃率的一种替代方法。我们进行了一项更新的系统评价和荟萃分析，以比较肝移植中NMP与静态冷藏（SCS）的效果。
检索MEDLINE、Embase和Cochrane数据库，查找随机对照试验（RCT）或观察性研究。计算风险比（RR）和均值差。p < 0.05被认为具有统计学意义。所有结局均采用随机效应模型。
PROSPERO注册号：CRD42023486184。
我们纳入了2016年至2023年的5项RCT和6项观察性研究中的1295例患者。592例（45.7%）接受了NMP。亚组RCT分析显示，NMP在非吻合口狭窄（RR 0.4；95%CI 0.2，0.9）、再灌注综合征（RR 0.4；95%CI 0.27，0.56）和早期移植物功能障碍（RR 0.6；95%CI 0.4，0.9）方面更具优势。NMP在器官利用率方面更高（RR 1.1；95%CI 1.02，1.??）。在移植肝存活或患者12个月生存率、原发性无功能、严重不良事件、总体胆道并发症、AST或胆红素水平在第1个7天内的峰值、ICU或住院时间方面，未观察到NMP和SCS之间存在显著差异。
我们的研究结果表明，在RCT亚组分析中，NMP与较低的非吻合口胆道狭窄率、再灌注综合征、早期移植物功能障碍以及更高的器官利用率相关，且不增加不良事件。 （注：原文中“RR 1.1；95%CI 1.02，1.??”这里95%CI的上限似乎有误，译文保留原文形式。）
