Cookies on this website

We use cookies to ensure that we give you the best experience on our website. If you click 'Accept all cookies' we'll assume that you are happy to receive all cookies and you won't see this message again. If you click 'Reject all non-essential cookies' only necessary cookies providing core functionality such as security, network management, and accessibility will be enabled. Click 'Find out more' for information on how to change your cookie settings.

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 post-reperfusion syndrome (PRS) (HMP OR 0.33, 0.15-0.75 CI; NMP OR 0.51, 0.29-0.90 CI) and early allograft dysfunction (EAD) (HMP OR 0.51, 0.35-0.75 CI; NMP OR 0.66, 0.45-0.97 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 0.52, 0.38-0.70 CI) and primary non-function (PNF) (OR 0.51, 0.27-0.98 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 post-operative 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) This article is protected by copyright. All rights reserved.

Original publication




Journal article


Clin Transplant

Publication Date



hypothermic machine perfusion (HMP), hypothermic oxygenated liver perfusion, hypothermic oxygenated perfusion (HOPE), liver transplant, liver transplantation, machine and perfusion, normothermic machine perfusion (NMP), normothermic regional machine perfusion, normothermic regional perfusion (NRP), organ preservation