ABSTRACT
Liver transplantation has become the most effective treatment for end-stage liver diseases.Due to the shortage of organ,more and more extended criteria donors (ECD) grafts had been used,which expand the liver pool.However,a series of complications post transplantation were caused by ischemia,hypoxia,steatosis and so on.The non-anastomotic biliary strictures after liver transplantation is one of the major complications when the ECD donors was be used in clinic.The study on the protective effect of machine perfusion on liver donors is too numerous to list,and existing studies have found that MP can reduce the incidence of NAS after liver transplantation.This review provides an overview of the pathogenesis of NAS and the reduction incidence of NAS by MP.
ABSTRACT
Objective To systematically review the effect of donor ischaemic preconditioning in liver transplantation.Methods Databases including the Cochrane Library,PubMed,EMbase,CNKI,VIP and WanFang database were searched up to June 2016 for studies which involved donor ischaemic preconditioning (IPC) in liver transplantation.The data retrieved included 1-year mortality,incidence of Primary Graft Non-Functioning (PGNF),intensive therapy unit (ICU) hospitalization and liver function tests which were used to evaluate the treatment outcomes.The data were analyzed using both the fixed-effect and the random-effects models.For categorical outcomes,risk ratio (RR) with 95％ confidence intervals (CI) were calculated.For continuous outcomes,the mean difference (MD) with 95％ CI were calculated.The metaanalysis was performed using Review Manager 5.2 software.Results Six clinical studies with 322 patients were qualified for this meta-analysis.There were no significant differences in the 1-year mortality (OR =0.51,95％ CI 0.24 ～ 1.05,P ＞ 0.05),PGNF (OR =0.33,95％ CI 0.08 ～ 1.40,P ＞ 0.05) and ICU hospitalization (OR =-0.17,95 ％ CI-2.72 ～ 2.38,P ＞ 0.05) between the donor ischaemic preconditioning and the control groups.There were also no significant differences in the transaminase and bilirubin levels on postoperative day 1,3 and 7 between the two groups.Conclusion There is currently not enough evidence in evidenced based medicine to recommend the routine use of ischaemic preconditioning in donor liver retrieval.
ABSTRACT
Liver transplantation has become the most effective treatment option for end-stage liver diseases.The liver donation after cardiac death (DCD) had been increasingly used in clinical practice.Nevertheless,the DCD donated livers inevitably exposed to long-term ischemia and hypoxia makes the implanted organs with decreased function and more postoperative complications.Different from the conventional static cold storage,machine perfusion (MP) can be continuously used in vitro liver perfusion,which could simulate the in vivo liver status.Through the observation of ischemia injury status,we could evaluate the quality of donated liver,and thus reduce ischemia related complications.This review provides an overview and evaluation on the markers that have been investigated for the assessment of graft quality and viability testing during different types of MP.