Machine perfusion delivers positive outcomes for liver transplantation

18 Nov 2023
Machine perfusion delivers positive outcomes for liver transplantation

Machine perfusion techniques are effective and appear to be better than static cold storage (SCS) in patients who underwent liver transplantation, suggest the results of a meta-analysis.

A team of investigators conducted a systematic search of Medline, Embase, Cinahl, and Central to identify randomized controlled trials (RCTs) comparing post-transplant outcomes following machine perfusion (ie, hypothermic oxygenated [HOPE] and normothermic machine perfusion [NMP]) versus SCS.

Random effect models were used to pool data, and risk ratios (RRs) were calculated for the relevant outcomes. Finally, the investigators used the GRADE framework to evaluate the quality of evidence.

Seven RCTs (four on HOPE and three on NMP), including a total of 1,017 patients, met the eligibility criteria. Both approaches resulted in significantly lower rates of early allograft dysfunction (NMP: n=41/282; SCS: n=74/253; RR, 0.50, 95 percent confidence interval [CI], 0.30‒0.86; p=0.01; I2, 39 percent; HOPE: n=45/241; SCS: n=97/241; RR, 0.48, 95 percent CI, 0.35‒0.65; p<0.00001; I2, 5 percent).

The HOPE technique significantly reduced major complications (Clavien Grade ≥IIIb; HOPE: n=90/241; SCS: n=117/241; RR, 0.76, 95 percent CI 0.63‒0.93; p=0.006; I2, 0 percent), retransplantation (HOPE: n=1/163; SCS: n=11/163; RR, 0.21, 95 percent CI, 0.04‒0.96; p=0.04; I2, 0 percent), and graft loss (HOPE: n=7/163; SCS: n=19/163; RR, 0.40, 95 percent CI, 0.17‒0.95; p=0.04; I2, 0 percent).

In addition, both HOPE and NMP appeared to potentially reduce overall biliary complications and nonanastomotic strictures.

“Although this study provides the highest current evidence on the role of machine perfusion, outcomes remain limited to a 1-year follow-up after liver transplantation,” the investigators said.

“Comparative RCTs and large real-world cohort studies with longer follow-up are required to enhance the robustness of the data further, thereby supporting the introduction of perfusion technologies into routine clinical practice,” they added.

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