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Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts

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 perfusio...

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Autores principales: Bellini, Maria Irene, Nozdrin, Mikhail, Yiu, Janice, Papalois, Vassilios
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723966/
https://www.ncbi.nlm.nih.gov/pubmed/31443179
http://dx.doi.org/10.3390/jcm8081221
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author Bellini, Maria Irene
Nozdrin, Mikhail
Yiu, Janice
Papalois, Vassilios
author_facet Bellini, Maria Irene
Nozdrin, Mikhail
Yiu, Janice
Papalois, Vassilios
author_sort Bellini, Maria Irene
collection PubMed
description 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.
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spelling pubmed-67239662019-09-10 Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts Bellini, Maria Irene Nozdrin, Mikhail Yiu, Janice Papalois, Vassilios J Clin Med Review 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. MDPI 2019-08-15 /pmc/articles/PMC6723966/ /pubmed/31443179 http://dx.doi.org/10.3390/jcm8081221 Text en © 2019 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Review
Bellini, Maria Irene
Nozdrin, Mikhail
Yiu, Janice
Papalois, Vassilios
Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts
title Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts
title_full Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts
title_fullStr Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts
title_full_unstemmed Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts
title_short Machine Perfusion for Abdominal Organ Preservation: A Systematic Review of Kidney and Liver Human Grafts
title_sort machine perfusion for abdominal organ preservation: a systematic review of kidney and liver human grafts
topic Review
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723966/
https://www.ncbi.nlm.nih.gov/pubmed/31443179
http://dx.doi.org/10.3390/jcm8081221
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