Abstract
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.
Highlights
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
These organs are associated with higher rates of discard due to an anticipated increased risk of primary non function (PNF) or delayed graft function (DGF); novel dynamic preservation technologies are increasingly being adopted with the aim to allow organ utilisation in these circumstances
The aim of this study is to provide evidence with a systematic review and metanalysis of the outcomes in terms of organ viability and incidence of reperfusion injury in hypothermic/normothermic machine perfusion (MP) in comparison to Static Cold Storage (SCS) in kidney and liver human grafts
Summary
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. In the last thirty years instead, with the change in demographics of the donor population and the idea of tailoring the preservation method to the single graft, the debate as to what is the optimal organ treatment prior to transplantation, along with the possibility to ideally let the parenchymal cells continue their metabolic activity before implantation, has led to a re-investigation of the technique of dynamic preservation [2] In this scenario, where the temperature setting seems to be a main determinant for the subsequent cell activity, and with no evidence for the gold standard temperature to store retrieved grafts before implantation, there are two main modalities as alternatives to SCS: hypothermic (0–4 ◦C) or normothermic (34–37 ◦C) machine perfusion
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