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Meta-Analysis
. 2021 Nov;34(11):2046-2060.
doi: 10.1111/tri.14121. Epub 2021 Oct 19.

A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation

Julie De Beule  1 , Katrien Vandendriessche  2 , Liset H M Pengel  3 , Maria Irene Bellini  4 , John H Dark  5 , Amelia J Hessheimer  6 , Hendrikus J A N Kimenai  7 , Simon R Knight  3   8 , Arne P Neyrinck  9   10 , David Paredes  11 , Christopher J E Watson  12   13 , Filip Rega  2   14 , Ina Jochmans  1   15
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Free article
Meta-Analysis

A systematic review and meta-analyses of regional perfusion in donation after circulatory death solid organ transplantation

Julie De Beule et al. Transpl Int. 2021 Nov.
Free article

Abstract

In donation after circulatory death (DCD), (thoraco)abdominal regional perfusion (RP) restores circulation to a region of the body following death declaration. We systematically reviewed outcomes of solid organ transplantation after RP by searching PubMed, Embase, and Cochrane libraries. Eighty-eight articles reporting on outcomes of liver, kidney, pancreas, heart, and lung transplants or donor/organ utilization were identified. Meta-analyses were conducted when possible. Methodological quality was assessed using National Institutes of Health (NIH)-scoring tools. Case reports (13/88), case series (44/88), retrospective cohort studies (35/88), retrospective matched cohort studies (5/88), and case-control studies (2/88) were identified, with overall fair quality. As blood viscosity and rheology change below 20 °C, studies were grouped as hypothermic (HRP, ≤20 °C) or normothermic (NRP, >20 °C) regional perfusion. Data demonstrate that RP is a safe alternative to in situ cold preservation (ISP) in uncontrolled and controlled DCDs. The scarce HRP data are from before 2005. NRP appears to reduce post-transplant complications, especially biliary complications in controlled DCD livers, compared with ISP. Comparisons for kidney and pancreas with ISP are needed but there is no evidence that NRP is detrimental. Additional data on NRP in thoracic organs are needed. Whether RP increases donor or organ utilization needs further research.

Keywords: donation after circulatory death; meta-analysis; regional perfusion; solid organ transplantation; systematic review.

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References

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