Normothermic Perfusion Versus Static Cold Storage in Liver Transplantation: A Meta-Analysis of Randomized Trials

Area of Science:

• Transplantation research
• Organ preservation techniques
• Surgical outcomes analysis

Background:

• Normothermic machine perfusion (NMP) offers a potential advancement over static cold storage (SCS) for preserving liver grafts.
• NMP may mitigate ischemia-reperfusion injury and enhance the usability of donor organs.

Purpose of the Study:

• To systematically review randomized controlled trials (RCTs) comparing NMP with SCS for adult liver transplantation.
• To evaluate the impact of NMP on key outcomes including early allograft dysfunction (EAD), organ utilization, and patient/graft survival.

Main Methods:

• A systematic review of RCTs was conducted using MEDLINE, EMBASE, and CENTRAL databases.
• Included studies compared end-ischemic NMP to SCS in adult liver transplant recipients.
• Primary outcomes assessed were EAD, organ utilization, survival, peak AST, PNF, and biliary complications.

Main Results:

• Four RCTs involving 801 patients were analyzed.
• NMP significantly reduced EAD (16.4% vs. 27.2%) and increased organ utilization (75.5% vs. 69.4%) compared to SCS.
• No significant differences were found in patient/graft survival, peak AST, or primary non-function; biliary complications trended favorably with NMP.

Conclusions:

• NMP demonstrates a benefit in reducing EAD and improving organ utilization in adult liver transplantation versus SCS.
• Current evidence suggests no significant differences in survival or major postoperative complications, though more extensive trials are warranted.
• Larger RCTs are necessary to fully elucidate the long-term advantages of NMP in liver transplantation.