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Abstract Introduction Several novel machine perfusion technologies have been developed which attempt to improve outcomes compared with ice-box static cold storage (SCS). We aimed to evaluate the effects of different methods of machine perfusion liver transplantation. Methods We used standard, extensive Cochrane search methods to identify randomised machine perfusion trials. Data extraction was performed independently by two authors. Pairwise random-effects meta-analysis was performed. We assessed bias using Risk of Bias 2 and used GRADE to assess certainty of evidence. Results We included seven randomised trials (1024 transplant recipients from 1301 randomised/included livers); four compared end-ischaemic hypothermic oxygenated perfusion (HOPE) with SCS, and three compared normothermic machine perfusion (NMP) with SCS. When compared with SCS, HOPE was associated with improvement in the following clinically relevant outcomes: graft survival (HR=0.45, 95% CI=0.23-0.87; P=0.02; high-certainty evidence), serious adverse events (OR=0.45, 0.22-0.91; P=0.03; moderate-certainty evidence) and clinically significant ischaemic cholangiopathy (OR=0.31, 0.11-0.92; P=0.03; high-certainty evidence). NMP was not associated with improvement in any of these clinically relevant outcomes, although evidence for these outcomes was low certainty. NMP was associated with improved utilisation compared with SCS (one trial found a 50% lower rate of organ discard; P = 0.008). Conclusions Where the decision has been made to transplant a DCD or marginal DBD liver, HOPE will provide superior clinically relevant outcomes compared with SCS alone (graft survival, adverse events, cholangiopathy). NMP appears to improve utilisation of grafts that would otherwise be discarded, but well-powered trials specifically designed to assess utilisation are required.
Tingle et al. (Fri,) studied this question.