Systematic Reviews
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplantation. Oct 22, 2018; 8(6): 220-231
Published online Oct 22, 2018. doi: 10.5500/wjt.v8.i6.220
Impact of machine perfusion of the liver on post-transplant biliary complications: A systematic review
Yuri L Boteon, Amanda PCS Boteon, Joseph Attard, Lorraine Wallace, Ricky H Bhogal, Simon C Afford
Yuri L Boteon, Amanda PCS Boteon, Joseph Attard, Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2WB, United Kingdom
Yuri L Boteon, Joseph Attard, Lorraine Wallace, Ricky H Bhogal, Simon C Afford, Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Birmingham B15 2 TT, United Kingdom
Yuri L Boteon, Joseph Attard, Lorraine Wallace, Ricky H Bhogal, Simon C Afford, National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University of Birmingham and University Hospitals Birmingham NHS Foundation Trust, Birmingham B15 2TT, United Kingdom
Author contributions: Boteon YL designed this study; Boteon YL and Boteon AP performed the literature review and analysis; Boteon YL, Attard J and Wallace L drafted the manuscript; Afford SC and Bhogal RH reviewed critically the manuscript; all authors contributed to editing and approved the final manuscript version.
Conflict-of-interest statement: The authors have no conflicts of interest to disclose.
PRISMA 2009 Checklist statement: This systematic review was performed in accordance with the Preferred Reporting Systematic Reviews and Meta-Analysis (PRISMA) 2009 protocol.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Simon C Afford, FRCP (Hon), PhD, Reader (Associate Professor), Centre for Liver and Gastrointestinal Research, Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham, Edgbaston, Birmingham B15 2 TT, United Kingdom. s.c.afford@bham.ac.uk
Telephone: +44-121-4158698
Received: August 1, 2018
Peer-review started: August 1, 2018
First decision: August 20, 2018
Revised: September 9, 2018
Accepted: October 9, 2018
Article in press: October 9, 2018
Published online: October 22, 2018
Processing time: 79 Days and 12.6 Hours
Abstract
AIM

To review the clinical impact of machine perfusion (MP) of the liver on biliary complications post-transplantation, particularly ischaemic-type biliary lesions (ITBL).

METHODS

This systematic review was performed in accordance with the Preferred Reporting Systematic Reviews and Meta-Analysis (PRISMA) protocol. The following databases were searched: PubMed, MEDLINE and Scopus. The keyword “liver transplantation” was used in combination with the free term “machine perfusion”. Clinical studies reporting results of transplantation of donor human livers following ex situ or in situ MP were analysed. Details relating to donor characteristics, recipients, technique of MP performed and post-operative biliary complications (ITBL, bile leak and anastomotic strictures) were critically analysed.

RESULTS

Fifteen articles were considered to fit the criteria for this review. Ex situ normothermic MP was used in 6 studies, ex situ hypothermic MP in 5 studies and the other 4 studies investigated in situ normothermic regional perfusion (NRP) and controlled oxygenated rewarming. MP techniques which have per se the potential to alleviate ischaemia-reperfusion injury: Such as hypothermic MP and NRP, have also reported lower rates of ITBL. Other biliary complications, such as biliary leak and anastomotic biliary strictures, are reported with similar incidences with all MP techniques. There is currently less clinical evidence available to support normothermic MP as a mitigator of biliary complications following liver transplantation. On the other hand, restoration of organ to full metabolism during normothermic MP allows assessment of hepatobiliary function before transplantation, although universally accepted criteria have yet to be validated.

CONCLUSION

MP of the liver has the potential to have a positive impact on post-transplant biliary complications, specifically ITBL, and expand extended criteria donor livers utilisation.

Keywords: Liver transplantation; Ex situ machine perfusion of the liver; Donation after circulatory death; Non-anastomotic intra-hepatic stricture; Ischemic-type biliary lesions; Extended criteria donors

Core tip: Post-transplant biliary complications are one of the main culprits responsible for the high patient morbidity following extended criteria donor liver transplantation. In its most severe form, ischaemic-type biliary lesions, can lead to graft failure and re-transplantation. Machine perfusion (MP) of the liver is a promising approach in reconditioning high-risk organs. Clinical studies have, so far, focussed on the impact of MP on hepatocellular function recovery and assessment. In this review we present the clinical evidence of the effect of MP on post-transplant biliary complications and discuss how, in the future, this approach can reduce these complications further.