Normothermic Machine Perfusion vs. Static Cold Storage in Liver Transplantation: A Systematic Review and Meta-Analysis.

IF 2.2 3区医学 Q3 ENGINEERING, BIOMEDICAL

Artificial organs Pub Date : 2025-01-30 DOI:10.1111/aor.14960

Patricia Viana, Samy Castillo-Flores, Maria M R Mora, Thamiris D D Cabral, Paulo N Martins, Michael Kueht, Isabella Faria

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引用次数: 0

Abstract

Background: Normothermic machine perfusion (NMP) represents an alternative to prolong liver preservation and reduce organ discard rates. We performed an updated systematic review and meta-analysis to compare NMP with static cold storage (SCS) in liver transplantation.

Methods: MEDLINE, Embase, and Cochrane were searched for randomized controlled trials (RCTs) or observational studies. Risk ratios (RR) and mean differences were calculated. p < 0.05 was considered significant. A random-effects model was applied for all outcomes.

Prospero id: CRD42023486184.

Results: We included 1295 patients from 5 RCTs and 6 observational studies from 2016 to 2023. 592 (45.7%) underwent NMP. A subgroup RCT analysis favored NMP for non-anastomotic strictures (RR 0.4; 95% CI 0.2, 0.9), postreperfusion syndrome (RR 0.4; 95% CI 0.27, 0.56), and early allograft dysfunction (RR 0.6; 95% CI 0.4, 0.9). NMP favored higher organ utilization rates (RR 1.1; 95% CI 1.02, 1.18). No significant differences between NMP and SCS were observed in graft survival or patient survival at 12 months, primary non-function, serious adverse events, overall biliary complications, AST, or bilirubin levels peak within the first 7 days, ICU or hospital length of stay.

Conclusion: Our findings suggest that NMP is associated with lower non-anastomotic biliary stricture rates, postreperfusion syndrome, early allograft dysfunction, and higher organ utilization in the RCT subgroup analysis, without increasing adverse events.

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常温机器灌注与静态冷藏在肝移植中的比较：系统综述和荟萃分析。

背景：常温机器灌注（NMP）是延长肝脏保存和减少器官丢弃率的另一种选择。我们进行了一项最新的系统综述和荟萃分析，比较了NMP和静态冷藏（SCS）在肝移植中的应用。方法：检索MEDLINE、Embase和Cochrane，检索随机对照试验（rct）或观察性研究。计算风险比（RR）和平均差异。p普洛斯彼罗id: CRD42023486184。结果：我们纳入了2016年至2023年5项随机对照试验和6项观察性研究的1295例患者。592例（45.7%）行NMP。亚组RCT分析支持NMP治疗非吻合口狭窄(RR 0.4；95% CI 0.2, 0.9)，灌注后综合征(RR 0.4；95% CI 0.27, 0.56)和早期同种异体移植物功能障碍(RR 0.6；95% ci 0.4, 0.9)。NMP有利于较高的器官利用率(RR 1.1；95% ci 1.02, 1.18)。NMP和SCS在移植物存活或患者12个月生存率、原发性无功能、严重不良事件、总胆道并发症、AST或前7天内胆红素水平峰值、ICU或住院时间方面均无显著差异。结论：我们的研究结果表明，在RCT亚组分析中，NMP与较低的非吻合口胆道狭窄发生率、灌注后综合征、早期同种异体移植物功能障碍和较高的器官利用率相关，但没有增加不良事件。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Artificial organs 工程技术-工程：生物医学

CiteScore

4.30

自引率

12.50%

发文量

303

审稿时长

4-8 weeks

期刊介绍： Artificial Organs is the official peer reviewed journal of The International Federation for Artificial Organs (Members of the Federation are: The American Society for Artificial Internal Organs, The European Society for Artificial Organs, and The Japanese Society for Artificial Organs), The International Faculty for Artificial Organs, the International Society for Rotary Blood Pumps, The International Society for Pediatric Mechanical Cardiopulmonary Support, and the Vienna International Workshop on Functional Electrical Stimulation. Artificial Organs publishes original research articles dealing with developments in artificial organs applications and treatment modalities and their clinical applications worldwide. Membership in the Societies listed above is not a prerequisite for publication. Articles are published without charge to the author except for color figures and excess page charges as noted.