Use of machine perfusion in livers showing steatosis prior to transplantation: a systematic review.Lai, Q., et al.
Updates in Surgery 2020 [record in progress]
The aim of this systematic review was to assess the role of machine pefusion (MP) in liver grafts with macrovesicular steatosis (MaS) prior to transplantation.
An electronic database search was carried out on MEDLINE, Scopus and Google Scholar up until April 2019. Data extraction was carried out by two independent authors. The Newcastle–Ottawa Quality Assessment Scale (NOS) was used to assess the quality of the included studies.
16 papers were included in the review.
The outcomes of interest were post-liver transplant (LT) alanine aminotransferase (ALT) peak, postoperative renal replacement therapy (RRT), primary non-function (PNF), re-transplantation, ischemia-type biliary lesion (ITBL) rate and death.
The systematic review aimed to assess the role of machine perfusion in the evaluation of liver grafts with macrovesicular steatosis (MaS). A comprehensive literature search was conducted and identified 16 studies (cohort studies, case series and case reports) that met the criteria for inclusion. It was not described whether study selection was done by independent reviewers, however data extraction was completed by two independent reviewers. The methodological quality of seven cohort studies was assessed by the Newcastle-Ottawa scale and showed good study quality. The 16 studies reported 54 cases of liver transplants performed using steatotic grafts. Reported MaS values of cases were minor (MaS value less than 30%) in 76% of cases and moderate to severe in 24% of cases. Machine perfusion consisted of hypothermic (41%) or normothermic (59%) perfusion. A summary of studies showed no differences in post-transplant death or severe complications between minor versus moderate to severe MaS. No correlation was found between MaS values and post-transplantation ALT peak.