Transplant Trial Watch

A systematic review and meta-analysis of donor ischaemic preconditioning in liver transplantation.

Robertson FP, Magill LJ, et al.

Transplant International 2016; 29(11): 1147-1154.


Aims
The study aimed to analyse the current evidence for donor ischaemic preconditioning (IPC) in liver transplantation.

Interventions
A systematic review of the literature was conducted by searching Ovid Medline, Embase and Cochrane CENTRAL up until January 2015. Trials examining the effect of IPC in deceased donor liver transplantation were included in the study. Patients undergoing living donor liver transplantation were excluded.

Participants
Adult deceased donor liver transplant recipients.

Outcomes
Primary outcomes were early graft failure and retransplantation within 3 months and mortality within 1 year. The secondary outcomes were episodes of acute rejection, length of time spent in the intensive therapy unit (ITU) and in hospital, number of days ventilated, incidence of postoperative transient renal support, infective complications and aspartate transferase (AST) levels on the 3rd postoperative day.

Follow-up
1 year

CET Conclusions
This systematic review aimed to find RCT evidence assessing ischaemic pre-conditioning. However the authors included 8 RCTs and 2 cohort studies. Unfortunately there is no quality assessment presented for the included studies. There are also a number from the same authors around similar times, raising the possibility of duplication. Without further information this cannot be resolved. The study was prospectively registered and sufficient databases were searched. Each meta-analysis included between 68 and 232 patients. There were no significant differences in the primary endpoints. The authors did find a significantly reduced day-3 AST when using ischaemic pre-conditioning. None of the trials individually had adequate power, and the authors calculated that studies of 660 and 974 patients would be required to power for primary non-function and 1-year mortality respectively.

Trial registration
Prospero - CRD42015016055

Funding source
No funding received