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Review
. 2019 Aug 15;8(8):1221.
doi: 10.3390/jcm8081221.

Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts

Maria Irene Bellini  1 , Mikhail Nozdrin  2 , Janice Yiu  3 , Vassilios Papalois  4   5
Affiliations
Review

Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts

Maria Irene Bellini et al. J Clin Med. .

Abstract

Introduction: To match the current organ demand with organ availability from the donor pool, there has been a shift towards acceptance of extended criteria donors (ECD), often associated with longer ischemic times. Novel dynamic preservation techniques as hypothermic or normothermic machine perfusion (MP) are increasingly adopted, particularly for organs from ECDs. In this study, we compared the viability and incidence of reperfusion injury in kidneys and livers preserved with MP versus Static Cold Storage (SCS).

Methods: Systematic review and meta-analysis with a search performed between February and March 2019. MEDLINE, EMBASE and Transplant Library were searched via OvidSP. The Cochrane Library and The Cochrane Central Register of Controlled Trials (CENTRAL) were also searched. English language filter was applied.

Results: the systematic search generated 10,585 studies, finally leading to a total of 30 papers for meta-analysis of kidneys and livers. Hypothermic MP (HMP) statistically significantly lowered the incidence of primary nonfunction (PMN, p = 0.003) and delayed graft function (DGF, p < 0.00001) in kidneys compared to SCS, but not its duration. No difference was also noted for serum creatinine or eGFR post-transplantation, but overall kidneys preserved with HMP had a significantly longer one-year graft survival (OR: 1.61 95% CI: 1.02 to 2.53, p = 0.04). Differently from kidneys where the graft survival was affected, there was no significant difference in primary non function (PNF) for livers stored using SCS for those preserved by HMP and NMP. Machine perfusion demonstrated superior outcomes in early allograft dysfunction and post transplantation AST levels compared to SCS, but however, only HMP was able to significantly decrease serum bilirubin and biliary stricture incidence compared to SCS.

Conclusions: MP improves DGF and one-year graft survival in kidney transplantation; it appears to mitigate early allograft dysfunction in livers, but more studies are needed to prove its potential superiority in relation to PNF in livers.

Keywords: hypothermic; machine perfusion; normothermic; organ preservation; temperature; transplant.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the systematic literature search.
Figure 2
Figure 2
Primary nonfunction in kidneys preserved via HMP and SCS.
Figure 3
Figure 3
DGF in kidneys preserved by hypothermic machine perfusion and cold storage.
Figure 4
Figure 4
DGF duration in kidneys preserved by HMP and SCS. DGF duration was measured in days. In papers marked with “*”, mean and standard deviation were calculated using the method described by Wan 2014 [5].
Figure 5
Figure 5
Acute rejection in Kidneys preserved via HMP and SC.
Figure 6
Figure 6
Comparison of one month post transplantation serum creatinine in kidneys preserved via HMP and SCS. In papers marked with “*”, mean and standard deviation were calculated using the method described by Wan 2014 [5].
Figure 7
Figure 7
One year graft survival in kidneys preserved via HMP and SCS.
Figure 8
Figure 8
Estimated glomerular filtration rate (eGFR) in kidneys preserved via HMP and SCS; eGFR day 7.
Figure 9
Figure 9
Estimated glomerular filtration rate (eGFR) in kidneys preserved via HMP and SCS; eGFR day 14.
Figure 10
Figure 10
Estimated glomerular filtration rate (eGFR) in kidneys preserved via HMP and SCS; eGFR day 365.
Figure 11
Figure 11
Primary nonfunction in livers preserved via HMP and SCS.
Figure 12
Figure 12
Primary nonfunction in livers preserved via NMP and SCS.
Figure 13
Figure 13
Early allograft dysfunction in livers preserved via HMP and SCS.
Figure 14
Figure 14
Early allograft dysfunction in livers preserved via NMP and SCS.
Figure 15
Figure 15
Peak serum AST in studies comparing HMP to SCS. In papers marked with “*”, mean and standard deviation were calculated using the method described by Wan 2014 [5].
Figure 16
Figure 16
Peak serum AST in studies comparing NMP to SCS. In papers marked with “*”, mean and standard deviation were calculated using the method described by Wan 2014 [5].
Figure 17
Figure 17
One week post transplantation peak serum total bilirubin in studies comparing HMP to SCS. In papers marked with “*”, mean and standard deviation were calculated using the method described by Wan 2014 [5].
Figure 18
Figure 18
One week post transplantation peak serum total bilirubin in studies comparing NMP to SCS. In papers marked with “*”, mean and standard deviation were calculated using the method described by Wan 2014 [5].
Figure 19
Figure 19
Post transplantation biliary stricture rates in studies comparing HMP to SCS.
See this image and copyright information in PMC

References

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