Compared efficacy of preservation solutions on the outcome of liver transplantation: Meta-analysis

World J Gastroenterol. 2018 Apr 28;24(16):1812-1824. doi: 10.3748/wjg.v24.i16.1812.


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

Methods: 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).

Results: 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.

Conclusion: 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; Meta-analysis; One-year post-transplant graft survival; Preservation solution; Primary non-function; Systematic review.

Publication types

  • Meta-Analysis
  • Review
  • Systematic Review

MeSH terms

  • Adenosine / therapeutic use
  • Allopurinol / therapeutic use
  • Disaccharides / therapeutic use
  • Electrolytes / therapeutic use
  • Glucose / therapeutic use
  • Glutamates / therapeutic use
  • Glutathione / therapeutic use
  • Graft Survival
  • Histidine / therapeutic use
  • Humans
  • Insulin / therapeutic use
  • Liver Transplantation / adverse effects
  • Liver Transplantation / methods*
  • Mannitol / therapeutic use
  • Odds Ratio
  • Organ Preservation / adverse effects
  • Organ Preservation / methods*
  • Organ Preservation Solutions / adverse effects
  • Organ Preservation Solutions / therapeutic use*
  • Potassium Chloride / therapeutic use
  • Primary Graft Dysfunction / etiology
  • Procaine / therapeutic use
  • Raffinose / therapeutic use
  • Randomized Controlled Trials as Topic
  • Risk Factors
  • Time Factors
  • Treatment Outcome


  • Bretschneider cardioplegic solution
  • Celsior
  • Disaccharides
  • Electrolytes
  • Glutamates
  • IGL-1 solution
  • Insulin
  • Organ Preservation Solutions
  • University of Wisconsin-lactobionate solution
  • Mannitol
  • Histidine
  • Procaine
  • Allopurinol
  • Potassium Chloride
  • Glutathione
  • Glucose
  • Adenosine
  • Raffinose