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.
Ramírez-Del Val A., Guarrera J., Porte RJ., Selzner M., Spiro M., Raptis DA., Friend PJ.
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.