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

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.

• Authors: Ahmer M Hameed, Germaine Wong, Jerome M Laurence, Vincent W T Lam, Henry C Pleass, Wayne J Hawthorne
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 19 Issue 11 Pg. 933-943 (11 2017) ISSN: 1477-2574 [Electronic] England
• PMID: 28844527 (Publication Type: Journal Article, Meta-Analysis, Review, Systematic Review)
• Copyright: Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

Chemical References

• Organ Preservation Solutions

Topics

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