TY - JOUR
T1 - Does machine perfusion improve immediate and short-term outcomes by enhancing graft function and recipient recovery after liver transplantation? A systematic review of the literature, meta-analysis and expert panel recommendations
AU - Ramírez-Del Val, Alejandro
AU - Guarrera, James
AU - the ERAS4OLT.org Working Group
AU - Porte, Robert J.
AU - Selzner, Markus
AU - Spiro, Michael
AU - Raptis, Dimitri Aristotle
AU - Friend, Peter J.
AU - Nasralla, David
N1 - Publisher Copyright:
© 2022 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.
PY - 2022/10
Y1 - 2022/10
N2 - Background: Recent evidence supports the use of machine perfusion technologies (MP) for marginal liver grafts. Their effect on enhanced recovery, however, remains uncertain. Objectives:To identify areas in which MP might contribute to an ERAS program and to provide expert panel recommendations. Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Methods: Systematic review and meta-analysis following PRISMA guidelines and recommendations using the GRADE approach. CRD42021237713. Results: Both hypothermic (HMP) and normothermic (NMP) machine perfusion demonstrated significant benefits in preventing postreperfusion syndrome (PRS) (HMP OR.33,.15-.75 CI; NMP OR.51,.29-.90 CI) and early allograft dysfunction (EAD) (HMP OR.51,.35-.75 CI; NMP OR.66,.45-.97 CI), while shortening LOS (HMP MD -3.9; NMP MD -12.41). Only NMP showed a significant decrease in the length of ICU stay (L-ICU) (MD -7.07, -8.76; -5.38 CI), while only HMP diminishes the likelihood of major complications. Normothermic regional perfusion (NRP) reduces EAD (OR.52,.38–.70 CI) and primary nonfunction (PNF) (OR.51,.27-.98 CI) without effect on L-ICU and LOS. Conclusions: The use of HMP decreases PRS and EAD, specifically for marginal grafts. This is supported by a shorter LOS and a lower rate of major postoperative complications (QOE; moderate | Recommendation; Strong). NMP reduces the incidence of PRS and EAD with associated shortening in L-ICU for both DBD and DCD grafts (QOE; moderate | Recommendation; High) This technology also shortens the length of hospital stay (QOE; low | Recommendation; Strong). NRP decreases the likelihood of EAD (QOE; moderate) and the risk of PNF (QOE; low) when compared to both DBD and SRR-DCD grafts preserved in SCS. (Recommendation; Strong).
AB - Background: Recent evidence supports the use of machine perfusion technologies (MP) for marginal liver grafts. Their effect on enhanced recovery, however, remains uncertain. Objectives:To identify areas in which MP might contribute to an ERAS program and to provide expert panel recommendations. Data sources: Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central. Methods: Systematic review and meta-analysis following PRISMA guidelines and recommendations using the GRADE approach. CRD42021237713. Results: Both hypothermic (HMP) and normothermic (NMP) machine perfusion demonstrated significant benefits in preventing postreperfusion syndrome (PRS) (HMP OR.33,.15-.75 CI; NMP OR.51,.29-.90 CI) and early allograft dysfunction (EAD) (HMP OR.51,.35-.75 CI; NMP OR.66,.45-.97 CI), while shortening LOS (HMP MD -3.9; NMP MD -12.41). Only NMP showed a significant decrease in the length of ICU stay (L-ICU) (MD -7.07, -8.76; -5.38 CI), while only HMP diminishes the likelihood of major complications. Normothermic regional perfusion (NRP) reduces EAD (OR.52,.38–.70 CI) and primary nonfunction (PNF) (OR.51,.27-.98 CI) without effect on L-ICU and LOS. Conclusions: The use of HMP decreases PRS and EAD, specifically for marginal grafts. This is supported by a shorter LOS and a lower rate of major postoperative complications (QOE; moderate | Recommendation; Strong). NMP reduces the incidence of PRS and EAD with associated shortening in L-ICU for both DBD and DCD grafts (QOE; moderate | Recommendation; High) This technology also shortens the length of hospital stay (QOE; low | Recommendation; Strong). NRP decreases the likelihood of EAD (QOE; moderate) and the risk of PNF (QOE; low) when compared to both DBD and SRR-DCD grafts preserved in SCS. (Recommendation; Strong).
UR - http://www.scopus.com/inward/record.url?scp=85129151035&partnerID=8YFLogxK
U2 - 10.1111/ctr.14638
DO - 10.1111/ctr.14638
M3 - Review article
C2 - 35279883
AN - SCOPUS:85129151035
SN - 0902-0063
VL - 36
JO - Clinical Transplantation
JF - Clinical Transplantation
IS - 10
M1 - e14638
ER -