Normothermic Machine Perfusion versus Cold Storage of Liver in Pig Model: A Meta-Analysis

Abstract

BackgroundNormothermic machine perfusion (NMP) is a novel strategy used for organ preservation. We aimed to determine the overall efficacy of NMP for liver preservation versus traditional static cold storage (CS).Material/MethodsWe performed a meta-analysis of the literature to evaluate the efficacy of NMP in experimental pig models of liver preservation. We use the standardized mean difference and 95% confidence intervals (CI) to calculate statistics and used the random effects model for the combined analysis of the results.ResultsA total of 16 studies from 12 published articles were included. The combined results showed that NMP significantly decreased alanine aminotransferase (ALT), aspartate aminotransferase (AST), and hyaluronic acid levels in serum or perfusate, significantly increased bile production, and had a similar 5–7-days survival rate after liver transplantation compared with the CS group.ConclusionsNMP provides superior graft preservation compared with CS in the pig model.

Optimizing Livers for Transplantation Using Machine Perfusion versus Cold Storage in Large Animal Studies and Human Studies: A Systematic Review and Meta-Analysis

“…However, our results showed no significant differences between different MP and CS preservation. This result is in accordance with previous meta-analyses [ 41 ]. Because the included study was small, the conclusion may have been incorrect.…”

“…This meta-analysis provides a comprehensive understanding of the current published literature regarding different MPs preservation of liver grafts versus cold storage prior to transplantation in large animal studies and clinical studies. Large animal study data showed that MP preservation significantly decreased ALT, LDH, and HA values compared to CS preservation, which is in accordance with previous meta-analyses [ 2 , 41 ]. However, previous meta-analyses also included small animal studies [ 2 ] or studies that only simulated reperfusion in vitro rather than with transplants in vivo [ 41 ].…”

“…Large animal study data showed that MP preservation significantly decreased ALT, LDH, and HA values compared to CS preservation, which is in accordance with previous meta-analyses [ 2 , 41 ]. However, previous meta-analyses also included small animal studies [ 2 ] or studies that only simulated reperfusion in vitro rather than with transplants in vivo [ 41 ]. These methods cannot truly reflect the real conditions that occur after clinical transplantation.…”

“…Liver function in donor organs is related to the recipient's prognosis after liver transplantation. Many enzymes are released into the blood when hepatocytes and mitochondrial membranes are damaged [ 41 ]. ALT, AST, and LDH are the most frequently used markers to assess liver function.…”

Machine Perfusion of Extended Criteria Donor Organs: Immunological Aspects

“…Briefly, hypothermic MP (HMP, 4-10 • C) is based on the concept that oxidative energy production by mitochondrial electron transport is sustained at reduced rates by keeping low temperatures (10). In contrast, normothermic MP (NMP, 37 • C) aims to provide an approximately near physiological environment for organs ex vivo (37). Subnormothermic MP (SNMP, ∼21 • C) is a halfway approach between HMP and NMP, while controlled oxygenated rewarming (COR) is a concept to rescue cold-stored marginal grafts by gentle oxygenated warming up prior to blood reperfusion (38,39).…”