Compared efficacy of preservation solutions on the outcome of liver transplantation: Meta-analysis

Abstract

Aim: To compare the effects of the four most commonly used preservation solutions on the outcome of liver transplantations.

Methods: A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the Cochrane Library databases up to January 31^st, 2017. The inclusion criteria were comparative, randomized controlled trials (RCTs) for deceased donor liver (DDL) allografts with adult and pediatric donors using the gold standard University of Wisconsin (UW) solution or histidine-tryptophan-ketoglutarate (HTK), Celsior (CS) and Institut Georges Lopez (IGL-1) solutions. Fifteen RCTs (1830 livers) were included; the primary outcomes were primary non-function (PNF) and one-year post-transplant graft survival (OGS-1).

Results: All trials were homogenous with respect to donor and recipient characteristics. There was no statistical difference in the incidence of PNF with the use of UW, HTK, CS and IGL-1 (RR = 0.02, 95%CI: 0.01-0.03, P = 0.356). Comparing OGS-1 also failed to reveal any difference between UW, HTK, CS and IGL-1 (RR = 0.80, 95%CI: 0.80-0.80, P = 0.369). Two trials demonstrated higher PNF levels for UW in comparison with the HTK group, and individual studies described higher rates of biliary complications where HTK and CS were used compared to the UW and IGL-1 solutions. However, the meta-analysis of the data did not prove a statistically significant difference: the UW, CS, HTK and IGL-1 solutions were associated with nearly equivalent outcomes.

Conclusion: Alternative solutions for UW yield the same degree of safety and effectiveness for the preservation of DDLs, but further well-designed clinical trials are warranted.

Keywords: Liver transplantation; Meta-analysis; One-year post-transplant graft survival; Preservation solution; Primary non-function; Systematic review.

Figure 1

PRISMA flowchart of search strategy with inclusions and exclusions.

Figure 2

Effects of preservation solutions on primary non-function. A: Meta-analysis of the relative risk (-RR-) of PNF comparing studies using different preservation solutions: UW vs Celsior and UW vs HTK; B: Forest plot for subgroup analysis of PNF; and C: Funnel plot for PNF in studies. Squares represent individual study effects, with the size of the box relating to the weight of the study in the meta-analysis. Each diamond represents a summary effect from meta-analysis. Horizontal bars represent 95% CIs. There is no evidence of a small study effect in the test or the formal plot. PNF: Primary non-function; RCTs: Randomized controlled trials; ES: Effect size; UW: University of Wisconsin solution; HTK: Histidine-tryptophan-ketoglutarate solution; CS: Celsior solution; IGL-1: Institut Georges Lopez solution.

Figure 3

Effects of preservation solutions on one-year post-transplant graft survival. A: Meta-analysis of the relative risk (-RR-) of OGS-1 comparing studies using different preservation solutions: UW vs Celsior and UW vs HTK; B: Forest plot for subgroup analysis of OGS-1; and C: Funnel plot for OGS-1 in studies. Squares represent individual study effects, with the size of the box relating to the weight of the study in the meta-analysis. Each diamond represents a summary effect from meta-analysis. Horizontal bars represent 95% CIs. There is no evidence of a small study effect in the test or the formal plot. OGS-1: One-year post-transplant graft survival; RR: Relative risk; RCTs: Randomized controlled trials; ES: Effect size; UW: University of Wisconsin solution; HTK: Histidine-tryptophan-ketoglutarate solution; CS: Celsior solution; IGL-1: Institut Georges Lopez solution.