Jeddou Heithem, Tzedakis Stylianos, Prudhomme Hector, Wautier Aline, Sumner Corentin, Nejma Eya Ben, Zorkot Mohamad Ali, De Rosa Raffaele Vincenzo, Mazzarella Gennaro, Chaouch Mohamed Ali, Samson Michel, Boudjema Karim
Department of Hepatobiliary and Digestive Surgery, University Hospital, Rennes 1 University, Rennes, France.
Inserm, EHESP, Irset (Institut De Recherche En Santé, Environnement Et travail) -UMR_S 1085, Univ Rennes, Rennes, France.
Clin Transplant. 2025 Nov;39(11):e70372. doi: 10.1111/ctr.70372.
Normothermic machine perfusion (NMP) is an alternative to static cold storage (SCS) for liver graft preservation, potentially reducing ischemia-reperfusion injury and improving organ utilization.
We systematically reviewed RCTs comparing end-ischemic NMP with SCS in adult liver transplantation (MEDLINE, EMBASE, CENTRAL to July 9, 2025). Outcomes of interest included early allograft dysfunction (EAD), organ utilization, patient and graft survival, peak AST, primary non-function (PNF), and biliary complications.
Four RCTs (801 patients; NMP 418; SCS 383) met inclusion. NMP reduced EAD [16.4% vs. 27.2%; RR 0.61, 95% confidence interval (95% CI) 0.38-0.99; p = 0.05] and increased organ utilization (75.5% vs. 69.4%; RR 1.10, 95% CI 1.02-1.18; p = 0.01). No significant differences were observed for patient or graft survival, peak AST, PNF, or biliary complications, though the latter trended in favor of NMP (RR 0.73, p = 0.07).
In adult liver transplantation, NMP reduces EAD and improves organ utilization compared with SCS, without significant differences in survival or major postoperative complications. Evidence remains limited to few trials; larger RCTs are needed to assess long-term benefits.
常温机器灌注（NMP）是肝脏移植中静态冷藏（SCS）的一种替代方法，可能减少缺血再灌注损伤并提高器官利用率。
我们系统回顾了比较成人肝移植中缺血后NMP与SCS的随机对照试验（截至2025年7月9日的MEDLINE、EMBASE、CENTRAL）。感兴趣的结果包括早期移植物功能障碍（EAD）、器官利用率、患者和移植物存活率、AST峰值、原发性无功能（PNF）和胆道并发症。
四项随机对照试验（801例患者；NMP组418例，SCS组383例）符合纳入标准。NMP降低了EAD发生率[16.4%对27.2%；风险比（RR）0.61，95%置信区间（95%CI）0.38 - 0.99；p = 0.05]，并提高了器官利用率（75.5%对69.4%；RR 1.10，95%CI 1.02 - 1.18；p = 0.01）。在患者或移植物存活率、AST峰值、PNF或胆道并发症方面未观察到显著差异，不过后者有有利于NMP的趋势（RR 0.73，p = 0.07）。
在成人肝移植中，与SCS相比，NMP降低了EAD发生率并提高了器官利用率，在存活率或主要术后并发症方面无显著差异。证据仍限于少数试验；需要更大规模的随机对照试验来评估长期益处。
