Machine perfusion in liver transplantation: a network meta-analysis

Tingle, Samuel James; Thompson, Emily; Figueiredo, Rodrigo; Mahendran, Balaji; Pandanaboyana, Sanjay

doi:10.1002/14651858.cd014685

Cited by 10 publications

(14 citation statements)

References 65 publications

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“…155 A Cochrane review by Tingle et al affirmed improved graft survival, reduced severe adverse events, and minimized ischemic biliary complications in DCD donors. 154 These findings, supported by high to moderate evidence, align with three other meta-analyses. [151][152][153] Maspero et al even found that organ perfusion techniques were associated with a lower incidence of acute cellular rejection, particularly in DCD grafts with HOPE.…”

Section: Normothermic Machine Perfusionsupporting

confidence: 81%

“…The treatment for nonanastomotic biliary strictures was reduced by almost four times in the HMP group [155]. A Cochrane review by Tingle et al affirmed improved graft survival, reduced severe adverse events, and minimized ischemic biliary complications in DCD donors [154]. These findings, supported by high to moderate evidence, align with three other meta-analyses [151][152][153].…”

Section: Hypothermic Machine Perfusion (Hmp)mentioning

confidence: 72%

“…Some meta-analyses suggest that normothermic perfusion may lower the incidence of early allograft dysfunction and potentially reduce biliary complications [151]. However, other metaanalyses reached different conclusions due to the substantial variability in the studies using normothermic perfusion techniques [152][153][154].…”

Section: Normothermic Machine Perfusion (Nmp)mentioning

confidence: 99%

“…151 However, other meta-analyses reached different conclusions due to the substantial variability in the studies using normothermic perfusion techniques. 152 153 154…”

Section: Perfusion Techniquesmentioning

confidence: 99%

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Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Liu,

Sethi,

et al. 2024

Semin Liver Dis

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Liver transplantation (LT) is a highly effective treatment for carefully selected patients with hepatocellular carcinoma (HCC). In this review, we explored the development of LT selection criteria and organ allocation policies, comparing original data to underscore their historical progression into the intricate task of quantitatively estimating pre- and post-LT survivals. We emphasized the role of biomarkers such as serum AFP, DCP, circulating tumor cells, and circulating tumor DNA in predicting patient outcomes. Additionally, we examined the transplant-associated survival benefits and the difficulties in accurately calculating these benefits. We also reviewed recent advancements in targeted therapy and checkpoint inhibitors for advanced, inoperable HCC and projected their integration into liver transplantation for HCC. We further discussed the growing use of living donor liver transplants in the United States and compared its outcomes with those of deceased donor liver transplants. Furthermore, we examined the progress in machine perfusion techniques, which have shown potential in improving patient outcomes and enlarging the donor pool. These advancements present opportunities to enhance LT patient survivals, refine selection criteria, establish new priority metrics, develop innovative bridging and downstaging strategies, and formulate redesigned LT strategies for HCC treatments.

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Section: Normothermic Machine Perfusionsupporting

confidence: 81%

Section: Hypothermic Machine Perfusion (Hmp)mentioning

confidence: 72%

Section: Normothermic Machine Perfusion (Nmp)mentioning

confidence: 99%

“…151 However, other meta-analyses reached different conclusions due to the substantial variability in the studies using normothermic perfusion techniques. 152 153 154…”

Section: Perfusion Techniquesmentioning

confidence: 99%

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Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

Liu,

Sethi,

et al. 2024

Semin Liver Dis

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“…8,9 The implementation of NLMP as a clinical routine has helped to ease logistics and increase organ utilization. 6,10 Herein, we summarize our experience with the systematic application of prolonged normothermic perfusion and subsequent transplantation of split liver grafts.…”

Section: Introductionmentioning

confidence: 99%

Normothermic Liver Machine Perfusion and Successful Transplantation of Split Liver Grafts: From Proof of Concept to Clinical Implementation

Krendl,

Cardini,

Laimer

et al. 2024

Transplantation

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Background. Normothermic liver machine perfusion (NLMP) is advancing the field of liver transplantation (LT). Beyond improved preservation and organ assessment, NLMP helps to increase organ utilization. We herein address the feasibility and merit of NLMP in split liver transplantation (SLT) to postpone the transplantation of the second split graft to the following day. Methods. We analyzed the perfusion characteristics and outcomes of all consecutive adult recipients who underwent SLT following NLMP from February 1, 2018, to June 30, 2023. The primary endpoint was 90-d graft and patient survival. Secondary endpoints were posttransplant complications and 90-d morbidity. Results. Three right and 3 extended right SLT following NLMP have been performed. NLMP was uneventful in all cases. Perfusion characteristics differed according to graft volume. Mean perfusion time was 17:00 h (±05:13) and bile production ranged between 8 and 21 mL/h. All split grafts fulfilled predefined center viability criteria during NLMP and were transplanted on the following day. The 90-d graft and patient survival rate was 100%. Three patients (50%) required an early relaparotomy, and 2 patients (33.3%) developed biliary complications. The 90-d morbidity as recorded by the comprehensive complication index was 62.7 (±24.7). Conclusion. NLMP of split liver grafts is technically feasible and safe. Through prolongation of preservation time, NLMP allows to safely postpone transplantation of the second split liver graft to the next day.

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