Impact of machine perfusion of the liver on post-transplant biliary complications: A systematic review

Table 1 Comparison between donor, recipient, perfusion characteristics and the reported rates of ischemic-type biliary lesions

Ref.	Yr	Perfusion type	Timing MP	n	Donor age	Donor risk index	Recipient age	Recipient MELD	DBD (n)	DCD (n)	DBD ITBL (%)	DCD ITBL (%)	CIT (min)	Func. WIT (min)	Re-Tx (n)
Ex situ normothermic machine perfusion
Nasralla et al[46]	2018	NMP	Preserv	121	56 (16-84)	1.73	55	13 (6-35)	87	34	7.4	11.1	126	21	3
Selzner et al[54]	2016	NMP	Preserv	10	48 (17-75)	1.9	57	21 (8-40)	8	2	0	0	103	NA	0
Bral et al[56]	2017	NMP	Preserv	9	56 (14-71)	1.6 (0.9-2.7)	53 (28-67)	13 (9-32)	6	3	0	0	167 (95-293)	22	0
Ravikumar et al[55]	2016	NMP	Preserv	20	58 (21-85)	NA	NA	12 (7-27)	16	4	0	0	NA	21	0
Watson et al[58]	2018	NMP	End-Isc	22	57	2.3	NA	NA	6	16	0	25	386	12	3
Mergental et al[57]	2016	NMP	End-Isc	5	49 (29-54)	2.3	56 (47-66)	8 (8-13)	1	4	0	0	422	28	0
Ex situ hypothermic non-oxygenated machine perfusion
Guarrera et al[59]	2015	HMP	End-Isc	31	57 (± 18)1	1.9 (± 0.5)1	57 (± 8.0)1	19 (± 5.9)1	31	0	9.7	NA	558	NA	0
Guarrera et al[37]	2010	HMP	End-Isc	20	39 (± 2.5)1	NA	55 (± 6.2)1	17 (± 7.4)1	20	0	5	NA	306	26	0
Ex situ hypothermic oxygenated machine perfusion
van Rijn et al[43]	2017	DHOPE	End-Isc	10	53 (47-57)	1.9 (1.5-2.2)	57 (54-62)	16 (15-22)	0	10	NA	10	331	15	0
Dutkowski et al[38]	2015	HOPE	End-Isc	25	54 (36-63)	NA	60 (57-64)	13 (9-15)	0	25	NA	0	188 (141-264)	31 (26-36)	0
Dutkowski et al[40]	2014	HOPE	End-Isc	8	54 (NA)	2.2 (NA)	60 (NA)	12 (NA)	0	8	NA	0	141 (NA)	31 (22-41)	0
In situ normothermic regional perfusion
De Carlis et al[60]2	2017	NRP	NRP	7	481	NA	541	10.61	0	7	NA	0	4141	33	0
Oniscu et al[49]	2014	NRP	NRP	11	46 (16-74)	NA	68 (43-74)	NA	0	11	NA	0	389 (169-450)	26 (13-48)	0
Minambres et al[50]	2017	NRP	NRP	11	58 (50-67)	NA	55 (± 13)1	NA	0	11	NA	0	266 (± 82.7)1	12 (11-16)	0
Controlled oxygenated rewarming
Hoyer et al[47]	2016	COR	End-Isc	6	58 (51-71)	1.9 (1.5-2.5)	52 (43-65)	18 (11-23)	6	0	0	NA	508 (369-870)	NA	0

¹Data presented as median or median (± SD), if available. Otherwise, all data presented as median (Interquartile range); ²Combined hypothermic oxygenated machine perfusion after normothermic regional perfusion. Six uncontrolled DCD were included in this study;

³Eurotransplant DRI. MP: Machine perfusion; MELD: Model for end stage liver disease; DBD: Donation after brain death; DCD: Donation after circulatory death; ITBL: Ischemic-type biliary lesions; CIT: Cold ischemic time; Func; WIT: Functional warm ischemic time; Re-Tx: Re-transplantation; NA: Not applicable or not available; Preserv: Preservation; End-Isc: End ischemic; NMP: Normothermic machine perfusion; HMP: Hypothermic machine perfusion; DHOPE: Dual vessel hypothermic oxygenated machine perfusion; HOPE: Hypothermic oxygenated machine perfusion; NRP: Normothermic regional perfusion; COR: Controlled oxygenated rewarming.

Table 2 Prevalence of bile leak and anastomotic biliary strictures between clinical studies using different techniques of machine perfusion of donor livers

Ref.	Yr	Study design	Perfusion type	Timing machine perfusion	n	DBD (n)	DCD (n)	Bile leak (n)	Anastomotic stricture (n)
Ex situ normothermic machine perfusion
Nasralla et al[46]	2018	RCT	NMP	Preservation	121	87	34	0	0
Selzner et al[54]	2016	PS	NMP	Preservation	10	8	2	0	0
Bral et al[56]	2017	PS	NMP	Preservation	9	6	3	0	0
Ravikumar et al[55]	2016	PS	NMP	Preservation	20	16	4	0	4 (DBD)
Watson et al[58]	2018	DS	NMP	End-Ischaemic	22	6	16	0	0
Mergental et al[57]	2016	DS	NMP	End-Ischaemic	5	1	4	0	0
Ex situ hypothermic non-oxygenated machine perfusion
Guarrera et al[59]	2015	PS	HMP	End-Ischaemic	31	31	0	1	0
Guarrera et al[37]	2010	NCS	HMP	End-Ischaemic	20	20	0	1	1
Ex situ hypothermic oxygenated machine perfusion
van Rijn et al[43]	2017	PS	DHOPE	End-Ischaemic	10	0	10	0	2
Dutkowski et al[38]	2015	PS	HOPE	End-Ischaemic	25	0	25	5 (in total)
Dutkowski et al[40]	2014	PS	HOPE	End-Ischaemic	8	0	8	1	1
In situ normothermic regional perfusion
De Carlis et al[60]1	2017	DS	NRP	NRP	7	0	7*	0	1
Oniscu et al[49]	2014	DS	NRP	NRP	11	0	11	1	1
Minambres et al[50]	2017	DS	NRP	NRP	11	0	11	NA	NA
Controlled Oxygenated Rewarming
Hoyer et al[47]	2016	PS	COR	End-Ischaemic	6	6	0	NA	NA

¹Combined hypothermic oxygenated machine perfusion after normothermic regional perfusion. Six uncontrolled DCD were included in this study. RCT: Randomised controlled trial; PS: Single-arm non-randomised pilot study; DS: Descriptive study; NCS: Non-randomised cohort studies; DBD: Donation after brain death; DCD: Donation after circulatory death; NA: Not applicable or not available; NMP: Normothermic machine perfusion; HMP: Hypothermic machine perfusion; DHOPE: Dual vessel hypothermic oxygenated machine perfusion; HOPE: Hypothermic oxygenated machine perfusion; NRP: Normothermic regional perfusion; COR: Controlled oxygenated rewarming.