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The Effect of Preservation Solutions for Storage of Liver Allografts on Transplant Outcomes: A Systematic Review and Meta-Analysis

O'Callaghan, John M. MBBS*,†; Morgan, Robert D. MBBS*; Knight, Simon R. MChir*,†; Morris, Peter J. FRS*,†

doi: 10.1097/SLA.0000000000000402
Review

Objective: The objective of this review was to systematically evaluate the evidence comparing preservation fluids for liver allografts on transplant outcomes.

Background: Adequate preservation of liver allografts for transplantation is essential for successful transplant outcomes. There are several preservation fluids available that have been specifically designed for the static cold storage of livers. These fluids differ in composition and cost.

Methods: literature search was performed using MEDLINE, EMBASE, Cochrane Library, Transplant Library, and the International Clinical Trials Registry Platform. Only randomized controlled trials were included. Studies were assessed for methodological quality. Primary outcomes were the risk of early dysfunction, primary nonfunction, retransplantation, patient survival, and graft survival. Secondary outcomes were serum biochemical parameters in the first week and biliary complications. Summary effects were calculated as relative risk and relative log survival with 95% confidence intervals (95% CIs).

Results: Sixteen randomized controlled trials met the full inclusion criteria (1619 livers). There is good evidence that the University of Wisconsin and Celsior solutions are associated with the same rates of early dysfunction (relative risk = 1.08, 95% CI = 0.63–1.86, P = 0.77), primary nonfunction (relative risk = 0.73, 95% CI = 0.22–2.40, P = 0.60), patient survival (relative log survival = 0.86, 95% CI = 0.58–1.28, P = 0.46), and graft survival (relative log survival = 0.85, 95% CI = 0.59–1.23, P = 0.39). There was no good evidence of any difference in outcomes when comparing histidine-tryptophan-ketoglutarate with either of the University of Wisconsin or Celsior solution, although data were limited.

Conclusions: Data from included studies suggest that preservation of deceased donor livers with the University of Wisconsin or Celsior solution results in equivalent outcomes.

Supplemental Digital Content is Available in the Text.A systematic review of randomized controlled trials was conducted to assess the effect of preservation solution on liver transplant outcomes. Sixteen studies were included. There is good evidence that the University of Wisconsin and Celsior solutions are associated with the same rates of early dysfunction, primary nonfunction, patient survival, and graft survival.

*Centre for Evidence in Transplantation, Royal College of Surgeons of England and London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom; and

Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom.

Reprints: John M. O'Callaghan, MBBS, Centre for Evidence in Transplantation, Royal College of Surgeons of England, 35-43 Lincoln's Inn Fields, London WC2A 3PE, United Kingdom. E-mail: jocallaghan@rcseng.ac.uk.

Disclosure: No financial support was received for the conduct of the study. Peter Morris chairs a Data and Safety Monitoring Board for Bristol Myers Squibb and has received lecture fees in the past from Novartis, Roche, Astellas, and Genzyme. Simon Knight has received a travel grant from Roche. The authors declare no other conflicts of interest.

Protocol registered with NIHR PROSPERO (registration No. CRD42012001720) on April 4, 2011.

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© 2014 by Lippincott Williams & Wilkins.