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
ARTICLE HIGHLIGHTS
Research background

The ever-growing discrepancy between donor organ availability and patients on the transplant waiting list has led to increased acceptance of extended criteria donors (ECD). However, ECD liver transplantation, mainly donation after circulatory death, is associated with poor patient and graft outcome. A major factor is the increased risk of biliary complications, in particular ischaemic type biliary lesions (ITBL). Machine perfusion (MP) of the liveris a promising tool to recondition ECD organs prior to transplantation. Therefore investigation of the impact of MP on post-transplant biliary complications is a highly relevant topic.

Research motivation

Understanding the current evidence available for the effect of MP on post-transplant biliary complications, in particular ITBL, may guide further studies in this field.

Research objectives

Revise the current clinical evidence available regarding the effect of MP on post-transplant biliary complications, focusing on ITBL.

Research methods

A systematic review was carried out with literature searches in PubMed, MEDLINE and Scopus databases. The keyword “liver transplantation” was used in combination with the free term “machine perfusion”. Only clinical studies reporting results of transplantation of donor human livers following ex situ or in situ MP were included.

Research results

MP techniques which have demonstrated the potential to mitigate ischaemia reperfusion injury, such as ex situ oxygenated hypothermic MP and in situ normothermic regional perfusion, 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. Clinical studies have focused on evaluation of hepatocellular function rather than biliary function and injury so far. The direct effects of MP on biliary tree integrity are still relatively under-researched and further studies are needed.

Research conclusions

Post-transplant biliary complications are a major obstacle to the wider utilisation of ECD livers. MP has the potential to have a positive impact on this issue, specifically ITBL, and expand ECD livers utilisation. Mechanistically, mitigation of ischaemia-reperfusion injury appears to be the key mechanism involved.

Research perspectives

Supplementation of the perfusion fluid during ex situ MP with drugs can stimulate protective/regenerative mechanisms of the biliary tree. Pharmacological strategies may potentially modulate progenitor cells proliferation and equilibrate the phospholipid/bile salts balance in the bile.