Review Article

Optimizing Livers for Transplantation Using Machine Perfusion versus Cold Storage in Large Animal Studies and Human Studies: A Systematic Review and Meta-Analysis

Table 1

Characteristics of the large animal studies and human studies included in this meta-analysis.

ReferencesSpeciesDonor typeWITMP typeNumbers (n)MP characteristicsPreservation solutionOutcomes
MPCSMPCS

Iwamoto [26] 
(2000)
pigDCDNRHMP448°C, 2h, PV:7-8mmHgUW-GUWSurvival, AST, HA,LDH
Michael [22]  
(2001)
pigDCD0/1hNMP6/66/637°C, 4h, LA:150ml/min, PV:250ml/minBloodUWSurvival, PNF, HA,INR
Brockmann [23] 
(2009)
pigHBD/ 
DCD
0/0/40 
min
NMP5/7/65/7/45/20h, LA:240ml/min, PV: 7.22mmHgBloodUWSurvival, AST, ALT, HA
Fondevila [27]  
(2011)
pigDCD25minNMP6635.3-37.5°C, 4h, LA: 40-60mm Hg, PV:8mmHgBloodUWSurvival, AST, bilirubin
Monbaliu [28]  
(2011)
pigDCDNRHMP864°C, 4h, LA:30mmHg, PV:7mmHg, nonoxygenatedUWUWSurvival, PNF, AST, HA, TNF-α
Fondevila [29]  
(2012)
pigDCD26minHMP564°C, 4h, LA:20-30mmHg, PV:4mmHgUWUWSurvival, AST, HA, bilirubin, bile salts
Knaak[30]  
(2014)
pigDCD45minSNMP5533°C, 3h, LA:60-80mm Hg,PV:4-8mmHgSteen+ 
erythrocyte
UWSurvival, AST, HA, LDH, CD31,INR and factor V
Fontes [31]  
(2015)
pigDCD35minSNMP6621°C, 7.5h, LA:18±2 mmHg, PV:3.5±0.5mmHgHBOC  
solution
UWSurvival, AST, ALT, HA, LDH, Bile production
Spetzler [32]  
(2016)
pigDCDNRSNMP8833°C, 3h, LA:50-60mmHg, PV:2-4mmHgUWUWSurvival, AST, ALT, bilirubin
Zhibin Zhang [33]  
(2016)
pigDCD0minNMP6637°C, LA:85-100mmHg, PV:8-10mmHgBloodUWAST, ALT, LDH
Goldaracena [24]  
(2016)
pigHBDNRNMP/ 
SNMP
5/55/533-37°C,4h, LA:60mmHg, PV:2-4mmHgSteen+ 
erythrocyte
Steen solutionSurvival, AST, HA, CD31, IL-6, TNF-α
Guarrera [34]  
(2010)
humanDCDNRHMP20204-6°C, 3-7h, Flow rates were0.667 ml/g liver/minvasosol  
solution
UWGraft survival, PNF,EAD,biliary complications, INR, AST, hospital stay
Guarrera [35]  
(2015)
humanECDNRHMP31304-6°C, 3-7h, Flow rates were0.667 ml/g liver/minvasosol  
solution
UWGraft survival, PNF, EAD,biliary complications, INR, AST, hospital stay
Dutkowski [25]  
(2015)
humanDCD/ 
DBD
36minHMP25/2550/5010°C, 1.5-2.5h, PV: 120–180 ml/minUWUWGraft survival, PNF,EAD,biliary complications, INR, AST, hospital stay, ICU stay
Ravikumar [36]  
(2016)
humanDCD/ 
DBD
21minNMP204037°C, 4h, LA: 60-75mmHg, PV:-1-2mmHgBloodUWGraft survival, PNF, EAD, INR, hospital stay, AST, ICU stay
Selzner [37]  
(2016)
humanHBD/ 
DCD
49minNMP103037°C, 4h, LA:200-400ml/min, PV:1200-1300ml/minSteen  
solution
HTK/UWGraft survival, INR, AST, hospital stay, ICU stay
Bral [38]  
(2017)
humanDCD/DBD0-26minNMP92737°C, 3.3-22.5h, LA and PV not reportedBloodHTK/UWGraft survival, PNF, EAD,biliary complications, INR, AST, hospital stay, ICU stay
van Rijn [39]  
(2017)
humanDCD 
15minHMP102010°C, 2h, LA: 20-30mmHg, PV: 5mmHgUWMPSUWGraft survival, hospital stay, ICU stay, biliary complications
Nasralla [40]  
(2018)
humanDCD/ 
DBD
21min 
NMP12110137°C, 24h, LA: 200-400ml/ min, PV: 1000-1200ml/minBloodUWGraft survival, hospital stay, ICU stay, AST, EAD, biliary complications,PNF

DCD: donation after circulatory death; HBD: heart beating donor; DBD: donation after brain death; WIT: warm ischemia time; MP: machine perfusion; CS: cold (static) storage; HMP: hypothermic machine perfusion; NMP: normothermic machine perfusion; SNMP: subnormothermic machine perfusion; LA: hepatic artery; PV: portal vein; UW: University of Wisconsin; UW-G: University of Wisconsin gluconate solution; HTK: histidine tryptophan ketoglutarate; HBOC: hemoglobin-based oxygen carrier; PNF: primary nonfunction; EAD: early allograft dysfunction; INR: international normalized ratio; HA: hyaluronic acid; ICU: intensive Care Unit; AST: aspartate amino-transferase; ALT: alanine transaminase; LDH: lactate dehydrogenase; CD31: cluster of differentiation 31; IL-6: interleukin-6; TNF-α: tumour necrosis factor α; NR: not report