Efekti strategija strojne perfuzije na različite tipove donora u transplantaciji jetre: sistematski pregled i meta-analiza.
International journal of surgery (London, England)
Sažetak istraživanja
Pozadina Sve veća upotreba donora sa proširenim kriterijumima (ECD) postavlja veće zahteve za očuvanje grafta. Mašinska perfuzija (MP) poboljšava ishode ortotopske transplantacije jetre (OLT), ali njeni efekti na različite tipove donora ostaju nejasni.
Cilj autora bio je procijeniti efekte hipotermične mašinske perfuzije (HMP), normotermne mašinske perfuzije (NMP) ili normotermne regionalne perfuzije (NRP) naspram statičkog hladnog skladištenja (SCS) na različite tipove donora. Materijali i metode Sprovedena je pretraga literature u kojoj je upoređivana efikasnost MP u odnosu na SCS u bazama podataka PubMed, Cochrane i EMBASE. Urađena je meta-analiza kako bi se dobili objedinjeni efekti MP na ECD, donaciju nakon cirkulatorne smrti (DCD) i donora nakon smrti moždanog stabla.
Rezultati Trideset devet studija je uključeno (devet randomiziranih kontroliranih studija i 30 kohortnih studija). U poređenju sa SCS, HMP je značajno smanjio rizik od neanastomotske bilijarne strikture (NAS) [odnos šanse (OR) 0,43, 95% interval pouzdanosti (CI) 0,26-0,72], velikih komplikacija (OR 0,55, 95% CI 0,39-0,78) i rane funkcije allografta (OR 0,78) 95% CI 0,32-0,65) i poboljšano jednogodišnje preživljavanje transplantata (OR 2,36, 95% CI 1,55-3,62) u ECD-OLT. HMP je takođe smanjio primarnu nefunkcionalnost (PNF) (OR 0,40, 95% CI 0,18-0,92) i akutno odbacivanje (OR 0,62, 95% CI 0,40-0,97). NMP je samo smanjio veće komplikacije u ECD-OLT (OR 0,56, 95% CI 0,34-0,94), bez povoljnih efekata na druge komplikacije i preživljavanje. NRP je smanjio ukupni rizik od NAS (OR 0,27, 95% CI 0,11-0,68), PNF (OR 0,43, 95% CI 0,22-0,85) i EAD (OR 0,58, 95% CI 0,42-0,80) i u međuvremenu se poboljšao 1-OR 2 ft. 95% CI 1,65-3,49) u kontrolnom DCD-OLT.
Zaključci HMP bi se trenutno mogao razmotriti za marginalne jetre jer sveobuhvatno poboljšava ishode ECD-OLT. NMP pomaže nekim ishodima u ECD-OLT, ali više dokaza u vezi NMP-ECD je opravdano. NRP značajno poboljšava DCD-OLT ishode i preporučuje se tamo gdje postoje duži periodi bez dodira.
Prikaži originalni naslov i sažetak na engleskom
Effects of machine perfusion strategies on different donor types in liver transplantation: a systematic review and meta-analysis.
Background The increasing use of extended criteria donors (ECD) sets higher requirements for graft preservation. Machine perfusion (MP) improves orthotopic liver transplantation (OLT) outcomes, but its effects on different donor types remains unclear. The authors' aim was to assess the effects of hypothermic machine perfusion (HMP), normothermic machine perfusion (NMP), or normothermic regional perfusion (NRP) versus static cold storage (SCS) on different donor types. Materials and methods A literature search comparing the efficacy of MP versus SCS in PubMed, Cochrane, and EMBASE database was conducted. A meta-analysis was performed to obtain pooled effects of MP on ECD, donation after circulatory death (DCD), and donor after brainstem death.
Results Thirty nine studies were included (nine randomized controlled trials and 30 cohort studies). Compared with SCS, HMP significantly reduced the risk of non-anastomotic biliary stricture (NAS) [odds ratio (OR) 0.43, 95% confidence interval (CI) 0.26-0.72], major complications (OR 0.55, 95% CI 0.39-0.78), and early allograft dysfunction (EAD) (OR 0.46, 95% CI 0.32-0.65) and improved 1-year graft survival (OR 2.36, 95% CI 1.55-3.62) in ECD-OLT. HMP also reduced primary non-function (PNF) (OR 0.40, 95% CI 0.18-0.92) and acute rejection (OR 0.62, 95% CI 0.40-0.97). NMP only reduced major complications in ECD-OLT (OR 0.56, 95% CI 0.34-0.94), without favorable effects on other complications and survival. NRP lowered the overall risk of NAS (OR 0.27, 95% CI 0.11-0.68), PNF (OR 0.43, 95% CI 0.22-0.85), and EAD (OR 0.58, 95% CI 0.42-0.80) and meanwhile improved 1-year graft survival (OR 2.40, 95% CI 1.65-3.49) in control DCD-OLT.
Conclusions HMP might currently be considered for marginal livers as it comprehensively improves ECD-OLT outcomes. NMP assists some outcomes in ECD-OLT, but more evidence regarding NMP-ECD is warranted. NRP significantly improves DCD-OLT outcomes and is recommended where longer non-touch periods exist.
Izvorni podaci
- DOI
- 10.1097/js9.0000000000000661
- PMID
- 37578436
- PMCID
- PMC10651255
- Provjereno
- 2026-07-26
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