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
Research background

The introduction of the University of Wisconsin (UW) solution for static cold storage of liver grafts was a breakthrough and has remained the conventional method of organ preservation. However, many alternative preservation solutions exist, and each is thought to offer an advantage over UW solution.

Research motivation

At present, 98% of liver transplantations use the UW, histidine-tryptophan-ketoglutarate (HTK), Celsior (CS) or Institute Georges Lopez (IGL-1) solution for the cold preservation of grafts. Previously, prospective trials have investigated their effects on liver transplant outcomes, but with contradictory results. Furthermore, no systematic review reports the effect of IGL-1, which was first used by 2003, as compared to other solutions.

Research objectives

To provide an update and to compare the latest findings from clinical trials on the effects of the four most frequently used preservation solutions on liver transplant outcomes.

Research methods

A systematic review and meta-analysis were conducted on randomized controlled trials of deceased donor liver transplantations using UW and either HTK, CS or IGL-1 for cold storage of allografts. Primary and secondary outcomes were primary non-function (PNF) and one-year post-transplant graft survival (OGS-1).

Research results

In spite of differences found in individual studies, a meta-analysis of PNF and OGS-1 showed no statistical difference between groups. Subgroup analysis showed no increased risk for other outcomes, such as primary dysfunction, early retransplantation rate, post-transplantation death and one-year post-transplant patient survival.

Research conclusions

This meta-analysis provided evidence that UW and alternative solutions are associated with almost the same transplant outcome. Further studies are needed with extended criteria donors to ascertain the superiority of any alternative solution over UW.