Effectiveness of machine perfusion in liver transplantation: A meta-analysis of randomized controlled trials

Background

In contemporary transplantation research, the utilization of machine perfusion to facilitate the perfusion, preservation, evaluation, and repair of donor livers has garnered considerable attention.In an effort to comprehensively assess the clinical outcomes of liver transplantation procedures incorporating machine perfusion, a meta-analysis of published randomized controlled trials (RCTs) was undertaken.

Methods

The relevant literature was obtained from PubMed, EMBASE, Web of Science, and other databases up until December 2022. Subsequently, the authors extracted the requisite data, conducted a meta-analysis, and arrived at a conclusion based on the findings derived from the analysis.

Results

A total of seven high-quality prospective RCTs, comprising 917 patients, were included in the analysis. Machine perfusion demonstrated significant superiority over cold storage in reducing the incidence of major postoperative complications (RR 0.55, 95% CI 0.42 to 0.73; p < 0.0001) and early allograft dysfunction (RR 0.52, 95% CI 0.41 to 0.67; p < 0.00001). Notably, postoperative aspartate aminotransferase peak, bilirubin levels, and post-reperfusion lactate were also found to decrease. However, no statistically significant differences were observed for other outcomes. Hypothermic oxygenation machine perfusion demonstrated a lower frequency of re-transplantation (RR 0.29, 95% CI 0.10 to 0.86; p = 0.03), rejection (RR 0.55, 95% CI 0.32 to 0.95; p = 0.03), and resulted in shorter hospital stays (Std, MD -0.30, 95% CI -0.52 to -0.07; p = 0.009).

Conclusions

The application of machine perfusion can yield significant improvements in the outcomes of liver transplantation.