Transplant Trial Watch

The hepatic protective effects of tacrolimus as a rinse solution in liver transplantation: A meta-analysis.

Guo, T., Lei, J. et al. (2019).

Medicine (Baltimore); 98(21): e15809.


Aims
To investigate the protective effects of tacrolimus as a rinse solution against ischaemia-reperfusion injury (IRI) in liver transplantation.

Interventions
The MEDLINE, EMBASE and Cochrane Central databases were searched to identify randomized controlled trials (RCTs) investigating the effects of tacrolimus as a rinse solution in liver transplantation. No restriction of publication time or status was applied.

Participants
3 RCTs, incuding 70 liver transplants investigating the effects of tacrolimus (20ng/mL) as a rinse solution were evaluated in this study.

Outcomes
Outcomes were assessed as postoperative liver function, including alanine aminotransferase (ALT), aspartate aminotransferase (AST) and total bilirubin (TBIL) at postoperative day (POD) 1, 2 and 7.

Follow-up
7 days

CET Conclusions
This meta-analysis looked at the evidence for tacrolimus-rinse to prevent ischaemia-reperfusion injury of liver allografts. It is a well-conducted meta-analysis, but was based upon just three RCTs, therefore limiting the power of the statistical analysis. The review was prospectively registered with the PROSPERO system. MEDLINE, EMBASE and the Cochrane database were searched for relevant studies with a sensitive search strategy, and only three RCTs were included. The potential risk of bias in the studies was assessed and presented clearly in the supplemental material. The pooled estimates showed no significant impact of tacrolimus rinse on post-operative serum ALT, AST or bilirubin. Tacrolimus rinse concentration was the same in all three RCTs. This systematic review was conducted to good standards, as described above, and even going as far as funnel plots to assess for publication bias, calculating egger’s tests, and doing a sensitivity analysis to exclude the one study with extended criteria donors. However, this does not change the fact that the three included RCTs were small and each individually did not show any benefit of the tacrolimus rinse. In conclusion, this review did not find clinical evidence to support the use of tacrolimus rinse solutions in liver transplantation.

Quality notes
Systematic review - QA not necessary

Trial registration
PROSPERO - 108191

Funding source
No funding received