Impact of machine perfusion of the liver on post-transplant biliary complications: A systematic review

作     者：Yuri L Boteon Amanda PCS Boteon Joseph Attard Lorraine Wallace Ricky H Bhogal Simon C Afford 

作者机构：Liver Unit Queen Elizabeth Hospital University Hospitals Birmingham NHS Foundation Trust Centre for Liver and Gastrointestinal Research Institute of Immunology and Immunotherapy College of Medical and Dental Sciences University of Birmingham National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre University of Birmingham and University Hospitals Birmingham NHS Foundation Trust 

出 版 物：《World Journal of Transplantation》 (世界移植杂志)

年 卷 期：2018年第8卷第6期

页      面：220-231页

学科分类：10[医学] 

基　　金：supported by the NIHR Birmingham Biomedical Research Centre at the University Hospitals Birmingham NHS Foundation Trust the University of Birmingham 

主　　题：Liver transplantation Ex situ machine perfusion of the liver Donation after circulatory death Non-anastomotic intra-hepatic stricture Ischemic-type biliary lesions Extended criteria donors 

摘      要：AIM To review the clinical impact of machine perfusion(MP) of the liver on biliary complications post-transplantation, particularly ischaemic-type biliary lesions(ITBL). METHODS This systematic review was performed in accordance with the Preferred Reporting Systematic Reviews and MetaAnalysis(PRISMA) protocol. The following databases were searched: PubMed, MEDLINE and Scopus. The keyword liver transplantation was used in combination with the free term machine perfusion. Clinical studies reporting results of transplantation of donor human livers following ex situ or in situ MP were analysed. Details relating to donor characteristics, recipients, technique of MP performed and post-operative biliary complications(ITBL, bile leak and anastomotic strictures) were critically *** Fifteen articles were considered to fit the criteria for this review. Ex situ normothermic MP was used in 6 studies, ex situ hypothermic MP in 5 studies and the other 4 studies investigated in situ normothermic regional perfusion(NRP) and controlled oxygenated rewarming. MP techniques which have per se the potential to alleviate ischaemia-reperfusion injury: Such as hypothermic MP and NRP, have also reported lower rates of ITBL. Other biliary complications, such as biliary leak and anastomotic biliary strictures, are reported with similar incidences with all MP techniques. There is currently less clinical evidence available to support normothermic MP as a mitigator of biliary complications following liver transplantation. On the other hand, restoration of organ to full metabolism during normothermic MP allows assessment of hepatobiliary function before transplantation, although universally accepted criteria have yet to be *** MP of the liver has the potential to have a positive impact on post-transplant biliary complications, specifically ITBL, and expand extended criteria donor livers utilisation.