Hypothermic machine perfusion reduces the incidences of early allograft dysfunction and biliary complications and improves 1-year graft survival after human liver transplantation: A meta-analysis

Abstract

Background: The worldwide organ shortage continues to be the main limitation of liver transplantation. To bridge the gap between the demand and supply of liver grafts, it becomes necessary to use extended criteria donor livers for transplantation. Hypothermic machine perfusion (HMP) is designed to improve the quality of preserved organs before implantation. In clinical liver transplantation, HMP is still in its infancy.

Methods: A systematic search of the PubMed, EMBASE, Springer, and Cochrane Library databases was performed to identify studies comparing the outcomes in patients with HMP versus static cold storage (SCS) of liver grafts. The parameters analyzed included the incidences of primary nonfunction (PNF), early allograft dysfunction (EAD), vascular complications, biliary complications, length of hospital stay, and 1-year graft survival.

Results: A total of 6 studies qualified for the review, involving 144 and 178 liver grafts with HMP or SCS preservation, respectively. The incidences of EAD and biliary complications were significantly reduced with an odds ratio (OR) of 0.36 (95% confidence interval [CI] 0.17-0.77, P = .008) and 0.47 (95% CI 0.28-0.76, P = .003), respectively, and 1-year graft survival was significantly increased with an OR of 2.19 (95% CI 1.14-4.20, P = .02) in HMP preservation compared to SCS. However, there was no difference in the incidence of PNF (OR 0.30, 95% CI 0.06-1.47, P = .14), vascular complications (OR 0.69, 95% CI 0.29-1.66, P = .41), and the length of hospital stay (mean difference -0.30, 95% CI -4.10 to 3.50, P = .88) between HMP and SCS preservation.

Conclusions: HMP was associated with a reduced incidence of EAD and biliary complications, as well as an increased 1-year graft survival, but it was not associated with the incidence of PNF, vascular complications, and the length of hospital stay.

Figure 1

The preferred reporting items for meta-analyses protocol flowchart illustrating the selection of studies included in our meta-analysis.

Figure 2

PNF rates for liver allografts preserved by HMP versus SCS in all studies. CI = confidence interval, HMP = hypothermic machine perfusion, M-H = Mantel–Haenszel test, PNF = primary nonfunction, SCS = static cold storage.

Figure 3

EAD rates for liver allografts preserved by HMP versus SCS in all studies. CI = confidence interval, EAD = early allograft dysfunction, HMP = hypothermic machine perfusion, M-H = Mantel–Haenszel test, SCS = static cold storage.

Figure 4

Vascular complication rates for liver allografts preserved by HMP versus SCS in all studies. CI = confidence interval, HMP = hypothermic machine perfusion, M-H = Mantel–Haenszel test, SCS = static cold storage.

Figure 5

Biliary complication rates for liver allografts preserved by HMP versus SCS in all studies. CI = confidence interval, HMP = hypothermic machine perfusion, M-H = Mantel–Haenszel test, SCS = static cold storage.

Figure 6

The length of hospital stay for liver allografts preserved by HMP versus SCS in all studies. CI = confidence interval, HMP = hypothermic machine perfusion, M-H = Mantel–Haenszel test, SCS = static cold storage.

Figure 7

One-year graft survival rates for liver allografts preserved by HMP versus SCS in all studies. CI = confidence interval, HMP = hypothermic machine perfusion, M-H = Mantel–Haenszel test, SCS = static cold storage.