Early outcome of machine perfusion vs static cold storage of liver graft: A systemic review and meta-analysis of randomized controlled trials

Abstract

Early outcomes of machine perfusion vs static cold storage of liver graft: A systemic review and meta-analysis of randomized controlled trialsBackground and aim: The use of marginal grafts is very challenging and it is associated with post reperfusion syndrome and early allograft dysfunction. The outcomes of machine perfusion for preservation of marginal graft has been compared with that of static cold storage with studies reporting reduced risk of ischemic cholangiopathy and graft loss. We perform this systematic review and meta-analysis of randomized controlled trials (RCTs) comparing outcomes of machine perfusion of liver graft compared to static cold storage (SCS) of liver graft during liver transplantation. Materials and methods: Two independent researchers thoroughly searched for literature in the following databases: PubMed (Medline), Cochrane Central Register of Controlled Studies (CENTRAL), clinical trial registry, research gate, google scholar and Scopus (ELSEVIER)databases (last search: November 2023). The search terms used were: "dynamic perfusion", "normothermic perfusion", "hypothermic perfusion", "liver transplantation", "static cold storage", "NMP", "HOPE", "extended criteria grafts", "Marginal grafts", "RCTs", "Randomized controlled trials", "warm ischemia" and "cold ischemia".Results: Eight RCTs published between 2019 to 2023 were included in the data synthesis and meta-analysis. The primary outcome we considered was overall incidence of early allograft dysfunction (EAD) between the two methods of graft perfusion after liver transplantation. The secondary outcome considered was rate of retransplantation. Our meta-analysis revealed that SCS is associated with more EAD when compared with machine perfusion with a P value of <0.00001. We also found that the rate of retransplantation is higher among patients that received liver that was preserved by SCS with a P value of 0.02. Conclusion:The use of machine perfusion in preservation of liver graft showed significant reduction in early allograft dysfunction and retransplantation.