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

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).