Compared efficacy of preservation solutions on the outcome of liver transplantation: Meta-analysis

doi:10.3748/wjg.v24.i16.1812

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World Journal of Gastroenterology

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Meta-Analysis

World J Gastroenterol. Apr 28, 2018; 24(16): 1812-1824
Published online Apr 28, 2018. doi: 10.3748/wjg.v24.i16.1812

Compared efficacy of preservation solutions on the outcome of liver transplantation: Meta-analysis

Ágnes Lilla Szilágyi, Péter Mátrai, Péter Hegyi, Eszter Tuboly, Daniella Pécz, András Garami, Margit Solymár, Erika Pétervári, Márta Balaskó, Gábor Veres, László Czopf, Bastian Wobbe, Dorottya Szabó, Juliane Wagner, Petra Hartmann

Ágnes Lilla Szilágyi, Eszter Tuboly, Daniella Pécz, Petra Hartmann, Institute of Surgical Research, University of Szeged, Szeged H-6720, Hungary

Péter Mátrai, Institute of Bioanalysis, University of Pécs, Pécs H-7624, Hungary

Péter Hegyi, András Garami, Margit Solymár, Erika Pétervári, Márta Balaskó, Institute for Translational Medicine and First Department of Medicine, University of Pécs, Pécs H-7624, Hungary

Péter Hegyi, MTA-SZTE Translational Gastroenterology Research Group, Szeged H-6720, Hungary

Péter Hegyi, János Szentágothai Research Center, University of Pécs, Pécs H-7624, Hungary

Gábor Veres, 1^st Department of Paediatrics, University of Semmelweis, Budapest H-1085, Hungary

László Czopf, Bastian Wobbe, Dorottya Szabó, Juliane Wagner, Department of Cardiology, 1^st Department of Medicine, University of Pécs, Pécs H-7624, Hungary

Author contributions: Szilágyi ÁL, Garami A, Solymár M, Pétervári E, Balaskó M and Hartmann P designed the study; Szilágyi ÁL, Tuboly E, Pécz D, Veres G, Szabó D and Wagner J collected and analyzed the data; Mátrai P performed the statistical analysis; Hartmann P drafted and wrote the manuscript; Wobbe B performed language editing; Hegyi P and Czopf L revised the manuscript critically for intellectual content; and all the authors provided intellectual input for the study and approved the final version of the manuscript.

Supported by grants from the National Research Development and Innovation Office, NKFI K120232; Hungarian Science Research Fund, No. GINOP 2.3.2-15-2016-00015 and No. EFOP-3.6.2-16-2017-00006; and New National Excellence Program of the Ministry of Human Capacities, No. UNKP-17-4.

Conflict-of-interest statement: None of the authors has any conflict of interests related to this manuscript.

Data sharing statement: No additional data are available.

Correspondence to: Petra Hartmann, MD, PhD, Assistant Professor, Institute of Surgical Research, University of Szeged, Szőkefalvi-Nagy Béla street 6, Szeged H-6720, Hungary. hartmann.petra@med.u-szeged.hu

Telephone: +36-62-545103 Fax: +36-62-545743

Received: January 31, 2018
Peer-review started: January 31, 2018
First decision: February 24, 2018
Revised: April 2, 2018
Accepted: April 9, 2018
Article in press: April 9, 2018
Published online: April 28, 2018
Processing time: 85 Days and 19.2 Hours

Abstract

AIM

To compare the effects of the four most commonly used preservation solutions on the outcome of liver transplantations.

METHODS

A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the Cochrane Library databases up to January 31^st, 2017. The inclusion criteria were comparative, randomized controlled trials (RCTs) for deceased donor liver (DDL) allografts with adult and pediatric donors using the gold standard University of Wisconsin (UW) solution or histidine-tryptophan-ketoglutarate (HTK), Celsior (CS) and Institut Georges Lopez (IGL-1) solutions. Fifteen RCTs (1830 livers) were included; the primary outcomes were primary non-function (PNF) and one-year post-transplant graft survival (OGS-1).

RESULTS

All trials were homogenous with respect to donor and recipient characteristics. There was no statistical difference in the incidence of PNF with the use of UW, HTK, CS and IGL-1 (RR = 0.02, 95%CI: 0.01-0.03, P = 0.356). Comparing OGS-1 also failed to reveal any difference between UW, HTK, CS and IGL-1 (RR = 0.80, 95%CI: 0.80-0.80, P = 0.369). Two trials demonstrated higher PNF levels for UW in comparison with the HTK group, and individual studies described higher rates of biliary complications where HTK and CS were used compared to the UW and IGL-1 solutions. However, the meta-analysis of the data did not prove a statistically significant difference: the UW, CS, HTK and IGL-1 solutions were associated with nearly equivalent outcomes.

CONCLUSION

Alternative solutions for UW yield the same degree of safety and effectiveness for the preservation of DDLs, but further well-designed clinical trials are warranted.

Keywords: Liver transplantation; Preservation solution; Primary non-function; One-year post-transplant graft survival; Systematic review; Meta-analysis

Core tip: The University of Wisconsin (UW) solution is the gold standard for static cold storage in liver transplantation. Numerous clinical trials have investigated the potential benefit of the most frequently used alternative solutions, histidine-tryptophan-ketoglutarate, Celsior and Institut Georges Lopez, but their results have been variable. This meta-analysis has reviewed the current evidence and found no significant differences in risk of transplant outcomes: primary non-function (RR = 0.02, 95%CI: 0.01-0.03, P = 0.36) and one-year post-transplant graft survival (RR = 0.80, 95%CI: 0.80-0.80, P = 0.37) between UW and the other examined solutions.