A systematic review and meta-analysis of cold in situ perfusion and preservation for pancreas transplantation

Ahmer M Hameed; Germaine Wong; Jerome M Laurence; Vincent W T Lam; Henry C Pleass; Wayne J Hawthorne

doi:10.1016/j.hpb.2017.07.012

A systematic review and meta-analysis of cold in situ perfusion and preservation for pancreas transplantation

HPB (Oxford). 2017 Nov;19(11):933-943. doi: 10.1016/j.hpb.2017.07.012. Epub 2017 Aug 24.

Authors

Ahmer M Hameed¹, Germaine Wong², Jerome M Laurence³, Vincent W T Lam⁴, Henry C Pleass⁵, Wayne J Hawthorne⁶

Affiliations

¹ Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
² Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Sydney School of Public Health, University of Sydney, Sydney, NSW, Australia; Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
³ Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia; Institute of Academic Surgery, Royal Prince Alfred Hospital, University of Sydney, Sydney, NSW, Australia.
⁴ Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
⁵ Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Department of Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia.
⁶ Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Westmead, NSW, Australia; Department of Surgery, Westmead Hospital, Westmead, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia. Electronic address: Wayne.Hawthorne@sydney.edu.au.

PMID: 28844527
DOI: 10.1016/j.hpb.2017.07.012

Abstract

Background: This study aimed to identify the most effective solution for in situ perfusion/preservation of the pancreas in donation after brain death donors, in addition to optimal in situ flush volume(s) and route(s) during pancreas procurement.

Methods: Embase, Medline and Cochrane databases were utilized (1980-2017). Articles comparing graft outcomes between two or more different perfusion/preservation fluids (University of Wisconsin (UW), histidine-tryptophan-ketoglutarate (HTK) and/or Celsior) were compared using random effects models where appropriate.

Results: Thirteen articles were included (939 transplants). Confidence in available evidence was low. A higher serum peak lipase (standardized mean difference 0.47, 95% CI 0.23-0.71, I² = 0) was observed in pancreatic grafts perfused/preserved with HTK compared to UW, but there were no differences in one-month pancreas allograft survivals or early thrombotic graft loss rates. Similarly, there were no significant differences in the rates of graft pancreatitis, thrombosis and graft survival between UW and Celsior solutions, and between aortic-only and dual aorto-portal perfusion.

Conclusion: UW cold perfusion may reduce peak serum lipase, but no quality evidence suggested UW cold perfusion improves graft survival and reduces thrombosis rates. Further research is needed to establish longer-term graft outcomes, the comparative efficacy of Celsior, and ideal perfusion volumes.

Publication types

Meta-Analysis
Review
Systematic Review

MeSH terms

Adult
Cold Temperature*
Female
Graft Survival
Humans
Male
Organ Preservation / adverse effects
Organ Preservation / methods*
Organ Preservation / mortality
Organ Preservation Solutions / adverse effects
Organ Preservation Solutions / therapeutic use*
Pancreas Transplantation / adverse effects
Pancreas Transplantation / methods*
Pancreas Transplantation / mortality
Pancreatectomy* / adverse effects
Pancreatectomy* / mortality
Perfusion / adverse effects
Perfusion / methods*
Perfusion / mortality
Postoperative Complications / etiology
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Young Adult

Substances

Organ Preservation Solutions