Normothermic machine perfusion versus static cold storage for liver transplantation: a systematic review and meta-analysis.

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Acta cirurgica brasileira Pub Date : 2026-09-11 eCollection Date: 2026-01-01 DOI:10.1590/acb415326

Miguel Lucas Silva Valente, Angela Claudia Paixão Soares de Magalhães, Hercules Magalhães Olivense do Carmo, Donizete Dalto Junior, Bryan de Sousa Dorea, Marina Marcon Zamban

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Abstract

Purpose: To compare the effectiveness of normothermic machine perfusion (NMP) with static cold storage (SCS) in preserving transplantable livers, focusing on early postoperative complications.

Methods: A PRISMA 2020-compliant search of PubMed, Embase, Scopus, Cochrane Library and Web of Science identified comparative studies of NMP versus SCS. Five studies met the criteria (two randomized controlled trials, and three observational cohorts; 630 recipients). Random-effects meta-analysis was performed in RStudio, reporting risk ratio (RR), 95% confidence interval (95%CI), p-value and heterogeneity (I2).

Results: NMP significantly lowered the incidence of composite early postoperative complications versus SCS (RR = 0.60; 95%CI 0.47-0.75; p < 0.0001), corresponding to a 40% relative risk reduction. Between-study heterogeneity was negligible (I2 = 0 %). Subgroup analyses revealed no significant effect modification by study design (p = 0.75), donation after circulatory death proportion (p = 0.91), preservation duration (p = 0.51), donor age (p = 0.59) or perfusion technique (p = 0.37).

Conclusion: NMP demonstrates clinically superior graft preservation compared with SCS, consistently reducing early complications after liver transplantation. Adoption of NMP may expand the use of marginal organs and improve post-transplant outcomes.

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常温机器灌注与静态冷藏对肝移植的影响：一项系统综述和荟萃分析。

目的：比较常温机器灌注（NMP）与静态冷库（SCS）保存移植肝的效果，重点观察术后早期并发症。方法：在PubMed， Embase, Scopus， Cochrane Library和Web of Science中检索符合PRISMA 2020标准的NMP与SCS的比较研究。5项研究符合标准（2项随机对照试验，3项观察性队列；630名接受者）。在RStudio中进行随机效应荟萃分析，报告风险比（RR）、95%置信区间（95% ci）、p值和异质性（I2）。结果：与SCS相比，NMP显著降低了术后早期复合并发症的发生率（RR = 0.60; 95%CI 0.47-0.75; p < 0.0001），相对风险降低40%。研究间异质性可忽略不计（I2 = 0%）。亚组分析显示，研究设计（p = 0.75）、循环死亡后供体比例（p = 0.91）、保存时间（p = 0.51）、供体年龄（p = 0.59）或灌注技术（p = 0.37）对供体无显著影响。结论：与SCS相比，NMP在临床上表现出更好的移植物保存能力，持续减少肝移植术后的早期并发症。采用NMP可以扩大边缘器官的使用并改善移植后的预后。

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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Acta cirurgica brasileira

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