Abdominal Normothermic Regional Perfusion in Donation After Circulatory Death: A Systematic Review and Critical Appraisal.van de Leemkolk, F. E. M., et al.
Transplantation 2020; [record in progress].
This study aimed to investigate the recent evidence on the added benefit of using abdominal normothermic regional perfusion (aNRP) as compared to local standard perfusion techniques.
An electronic database search was carried out on Pubmed, Web of Science, MEDLINE, Cochrane library, ScienceDirect, Emcare, Google Scholar and Academic Search Premier. Study screening, data extraction and quality assessment were performed by two independent reviewers. The risk of bias was assessed using the Risk of Bias In Nonrandomized Studies of Interventions tool.
24 studies were included
The primary outcomes were 1-year patient and graft survival, and the organ utilization rate (OUR). The secondary outcomes were primary nonfunction (PNF), early allograft dysfunction, delayed graft function, estimated glomerular filtration rate (eGFR), serum creatinine and biliary complications.
This paper reports a systematic review on abdominal normothermic regional perfusion (ANRP) in donation after circulatory death. The systematic review was conducted to good standards, following the PRISMA guidelines, pre-registering a protocol and searching multiple databases. Titles and abstracts were also screened in duplicate by independent reviewers, and risk of bias assessed independently, although it is not clear if data was also extracted in duplicate. Twenty-four studies were included, and all were observational in design, 7 with no control group. A particular strength of the paper is the clear presentation of the bias assessment, with 11 studies judged to have a serious risk of overall bias, and 5 more a moderate risk of overall bias. The studies were published between 1986 and the current date, and included between 5 and 186 donors. The 2 largest studies were national registry analyses. The included studies were heterogeneous and so a narrative review has been conducted. In both kidney and liver transplantation there was no consistent evidence of increased organ utilisation rate or 1-year graft survival compared to standard retrieval practice. Only 3 studies presented results for pancreas or islet transplantation with no conclusive comparative outcomes. This is a good quality systematic review that shows ANRP is both feasible and safe. However, there is little evidence from within studies that ANRP is superior to standard practice, it is only when comparing between studies that there may be some benefit. The paper finishes with guidance for the design of studies of ANRP and acknowledges that a randomised controlled trial comparing to standard cold preservation is needed in controlled DCD. In uncontrolled DCD a trial like this may be of less significance and more difficult to achieve.
PROSPERO - CRD42019125387