Liver transplant outcomes after ex vivo machine perfusion: a meta-analysis

Abstract

Background The pressure on liver-transplant programmes has expanded the usage of extended-criteria allografts. Machine perfusion may be better than conventional static cold storage (SCS) in alleviating ischaemia–reperfusion injury in this setting. Recipient outcomes with hypothermic or normothermic machine perfusion were assessed against SCS here. Methods A search in MEDLINE, EMBASE and Scopus was conducted in February 2021. Primary studies investigating ex vivo machine perfusion were assessed for the following outcomes: morbidity, ICU and hospital stay, graft and patient survival rates and relative costs. Meta-analysis was performed to obtain pooled summary measures. Results Thirty-four articles involving 1742 patients were included, of which 20 were used for quantitative synthesis. Odds ratios favoured hypothermic machine perfusion (over SCS) with less early allograft dysfunction, ischaemic cholangiopathy, non-anastomotic strictures and graft loss. Hypothermic machine perfusion was associated with a shorter hospital stay and normothermic machine perfusion with reduced graft injury. Two randomized clinical trials found normothermic machine perfusion reduced major complication risks. Conclusion Machine perfusion assists some outcomes with potential cost savings.

Application of Ex Vivo Normothermic Machine Perfusion in Deceased Donors With Acute Kidney Injury With Successful Renal Transplantation: A Preliminary Experience

“…Ex vivo NMP preservation technology has shown level 1 evidence in reducing graft injuries in liver transplantation and has shown mitigation of IRI in marginal grafts in heart transplantation. 9 , 11 …”

“…Ex vivo NMP preservation technology has shown level 1 evidence in reducing graft injuries in liver transplantation and has shown mitigation of IRI in marginal grafts in heart transplantation. 9,11 There are limited published prospective studies on ex vivo NMP of kidneys to date. 12,14,15,17,26 The present study is the first human clinical kidney NMP study reporting the study center's preliminary experience with NMP of deceased donor kidneys with AKI (predominantly 80% stage 3 AKI kidneys), detailing successful kidney transplants performed after 135-150 min of NMP using an oxygenated red cell-based perfusate and also describes their short-term outcomes.…”

Machine perfusion organ preservation: Highlights from the American Transplant Congress 2022

“…Machine perfusion (MP) may mitigate ischemia–reperfusion injury (IRI), the Achilles heel of organ transplantation 2,3 . Therefore, MP may play a role in preventing all post‐transplant complications related to IRI, including primary non‐function, early allograft dysfunction (EAD), biliary complications, and recipient death 4 . In addition, equally important, mitigating IRI has the potential to increase the number of organs available for transplantation, decrease the length of hospital stay, and decrease the overall cost, which are important clinical goals to improve patient outcomes 1,4 …”

“…2,3 Therefore, MP may play a role in preventing all posttransplant complications related to IRI, including primary non-function, early allograft dysfunction (EAD), biliary complications, and recipient death. 4 In addition, equally important, mitigating IRI has the potential to increase the number of organs available for transplantation, decrease the length of hospital stay, and decrease the overall cost, which are important clinical goals to improve patient outcomes. 1,4 The American Transplant Congress (ATC) is the joint annual meeting of the American Society of Transplant Surgeons (ASTS) and the American Society of Transplantation (AST).…”

“…4 In addition, equally important, mitigating IRI has the potential to increase the number of organs available for transplantation, decrease the length of hospital stay, and decrease the overall cost, which are important clinical goals to improve patient outcomes. 1,4 The American Transplant Congress (ATC) is the joint annual meeting of the American Society of Transplant Surgeons (ASTS) and the American Society of Transplantation (AST). Traditionally, it offers knowledge on cutting-edge advances in research and provides an opportunity to discuss ideas and center-specific clinical practice in solid organ and tissue transplantation.…”