den Dekker Abraham M P, Franssen Alexander, Steyerberg Ewout W, Lam Hwai-Ding, Doppenberg Jason B, Alwayn Ian P J
LUMC Transplant Center, Leiden University Medical Center, Leiden, the Netherlands.
Department of Surgery, Leiden University Medical Center, Leiden, the Netherlands.
Liver Int. 2025 Jun;45(6):e70116. doi: 10.1111/liv.70116.
During normothermic machine perfusion (NMP), a variety of criteria are used to gauge the suitability of an organ for transplantation. However, the relations between donor factors and these criteria are poorly understood. The aim of this meta-analysis was to investigate the association between donor-related risk factors and the decision to transplant a liver subjected to NMP.
A comprehensive literature search was performed for articles published up to March 2025 in four databases, reporting livers subjected to NMP for viability assessment prior to transplantation. Effect size (ES) was calculated using Cohen's D and log odds ratio.
Out of 806 unique articles, 18 were included in this meta-analysis, encompassing 690 liver grafts that underwent NMP. Following viability assessment during NMP, utilisation rate was 82% from donors after brain death and 68% from donors after circulatory death (ES: 0.08, p = 0.88). Transplanted livers had shorter cold ischemia time (ES: -0.34, p = 0.003) and lower liver weight (ES: -0.53, p < 0.001). Donor age, BMI and donor warm ischemia time did not differentiate between transplanted and unused groups. Differences were observed in viability assessment for lactate clearance (ES: 2.0, p = 0.005), glucose metabolism (ES: 2.2, p < 0.001), bile production (ES: 1.0, p = 0.003) and pH (ES: 1.9, p < 0.001). Excellent outcomes, including 10% non-anastomotic strictures, 89% graft survival and 93% patient survival, were achieved in a large cohort of high-risk livers.
Cold ischemia time and liver weight were identified as donor-related risk factors, whereas donor type, age and donor warm ischemia time appear not to impact the decision to transplant during NMP.
在常温机器灌注（NMP）期间，使用多种标准来评估器官移植的适用性。然而，供体因素与这些标准之间的关系却鲜为人知。本荟萃分析的目的是研究供体相关危险因素与接受NMP的肝脏移植决策之间的关联。
对截至2025年3月在四个数据库中发表的文章进行全面文献检索，报告接受NMP进行移植前生存能力评估的肝脏。效应大小（ES）使用Cohen's D和对数比值比计算。
在806篇独特文章中，18篇纳入本荟萃分析，涵盖690例接受NMP的肝移植。在NMP期间进行生存能力评估后，脑死亡供体的肝脏利用率为82%，循环死亡供体的肝脏利用率为68%（ES：0.08，p = 0.88）。移植的肝脏冷缺血时间较短（ES：-0.34，p = 0.003）且肝脏重量较低（ES：-0.53，p < 0.001）。供体年龄、体重指数和供体热缺血时间在移植组和未使用组之间无差异。在乳酸清除率（ES：2.0，p = 0.005）、葡萄糖代谢（ES：2.2，p < 0.001）、胆汁生成（ES：1.0，p = 0.003）和pH值（ES：1.9，p < 0.001）的生存能力评估中观察到差异。在一大组高危肝脏中取得了优异的结果，包括10%的非吻合口狭窄、89%的移植物存活和93%的患者存活。
冷缺血时间和肝脏重量被确定为供体相关危险因素，而供体类型、年龄和供体热缺血时间似乎不影响NMP期间的移植决策。
