Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
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, 1st Department of Paediatrics, University of Semmelweis, Budapest H-1085, Hungary
László Czopf, Bastian Wobbe, Dorottya Szabó, Juliane Wagner, Department of Cardiology, 1st 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.
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:
Correspondence to: Petra Hartmann, MD, PhD, Assistant Professor, Institute of Surgical Research, University of Szeged, Szőkefalvi-Nagy Béla street 6, Szeged H-6720, Hungary.
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

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


A systematic literature search was performed using MEDLINE, Scopus, EMBASE and the Cochrane Library databases up to January 31st, 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).


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.


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.