Abstract
As a result of donation after circulatory death liver grafts' poor tolerance to cold storage, there has been increasing research interest in normothermic machine perfusion. This study aims to systematically review the current literature comparing normothermic perfusion to cold storage in donation after circulatory death liver grafts and complete a meta-analysis of published large animal and human studies. A total of nine porcine studies comparing cold storage to normothermic machine perfusion for donation after circulatory death grafts were included for analysis. There was a significant reduction in AST (mean difference −2291 U/L, CI (−3019, −1563); P ≤ 0.00001) and ALT (mean difference −175 U/L, CI (−266, −85); P = 0.0001), for normothermic perfusion relative to static cold storage, with moderate (I2 = 61%) and high (I2 = 96%) heterogeneity, respectively. Total bile production was also significantly higher (mean difference = 174 ml, CI (155, 193); P ≤ 0.00001). Further research focusing on standardization, performance of this technology following periods of cold storage, economic implications, and clinical trial data focused on donation after circulatory death grafts will be helpful to advance this technology toward routine clinical utilization for these grafts.
Highlights
Liver transplant remains the only definitive therapy for end stage liver disease
The aim of this paper is to systematically review the current literature comparing normothermic machine perfusion (NMP) to static cold storage (SCS) in donation after circulatory death (DCD) liver grafts in large animal and human studies
201 titles were excluded for the following reasons: published abstract with no complete full text article, comparison of hypothermic or subnormothermic perfusion without NMP, and studies without DCD grafts
Summary
Liver transplant remains the only definitive therapy for end stage liver disease. the shortage of quality organs remains significant in the United States with 1673 patients dying while on the waitlist and a further 1227 removed, too sick to undergo transplant during 2015 [1]. There has been a rise in the use of extended criteria donors (ECD). These donors include those with significant steatosis, advanced age, and donation after circulatory death (DCD) liver grafts [2]. The number of DCD grafts used continues to increase; there is a rise in the percentage of DCD grafts recovered but not transplanted [1]. This is a result of these grafts’ poor tolerance to static cold storage (SCS) [3], the current standard for organ preservation.
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