Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts

Journal of Clinical Medicine

MariaIrene Bellini¹  Vassilios Papalois²  Mikhail Nozdrin³  Janice Yiu⁴ 

[1] Renal Transplant Centre, Belfast City Hospital, Belfast BT97AB, UK;Renal and Transplant Directorate, Imperial College Healthcare NHS Trust, London W120HS, UK;School of Medicine, Imperial College London, London SW72AZ, UK;School of Medicine, University College London, London WC1E 6BT, UK;

关键词: machine perfusion;    organ preservation;    temperature;    hypothermic;    normothermic;    transplant;   

DOI  :  10.3390/jcm8081221

来源: DOAJ

【 摘 要 】

Introduction: To match the current organ demand with organ availability from the donor pool, there has been a shift towards acceptance of extended criteria donors (ECD), often associated with longer ischemic times. Novel dynamic preservation techniques as hypothermic or normothermic machine perfusion (MP) are increasingly adopted, particularly for organs from ECDs. In this study, we compared the viability and incidence of reperfusion injury in kidneys and livers preserved with MP versus Static Cold Storage (SCS). Methods: Systematic review and meta-analysis with a search performed between February and March 2019. MEDLINE, EMBASE and Transplant Library were searched via OvidSP. The Cochrane Library and The Cochrane Central Register of Controlled Trials (CENTRAL) were also searched. English language filter was applied. Results: the systematic search generated 10,585 studies, finally leading to a total of 30 papers for meta-analysis of kidneys and livers. Hypothermic MP (HMP) statistically significantly lowered the incidence of primary nonfunction (PMN, p = 0.003) and delayed graft function (DGF, p < 0.00001) in kidneys compared to SCS, but not its duration. No difference was also noted for serum creatinine or eGFR post-transplantation, but overall kidneys preserved with HMP had a significantly longer one-year graft survival (OR: 1.61 95% CI: 1.02 to 2.53, p = 0.04). Differently from kidneys where the graft survival was affected, there was no significant difference in primary non function (PNF) for livers stored using SCS for those preserved by HMP and NMP. Machine perfusion demonstrated superior outcomes in early allograft dysfunction and post transplantation AST levels compared to SCS, but however, only HMP was able to significantly decrease serum bilirubin and biliary stricture incidence compared to SCS. Conclusions: MP improves DGF and one-year graft survival in kidney transplantation; it appears to mitigate early allograft dysfunction in livers, but more studies are needed to prove its potential superiority in relation to PNF in livers.

【 授权许可】

Unknown