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A systematic review and meta-analysis of donor ischaemic preconditioning in liver transplantation

Robertson, Francis P.; Magill, Louise J.; Wright, Graham P.; Fuller, Barry; Davidson, Brian R.

Authors

Francis P. Robertson

Louise J. Magill

Barry Fuller

Brian R. Davidson



Abstract

Ischaemic preconditioning (IPC) is a strategy to reduce ischaemia–reperfusion (IR) injury. Its benefit in human liver transplantation is unclear. The aim of this study was to analyse the current evidence for donor IPC in liver transplantation. Systematic review and meta‐analysis of studies involving IPC of liver transplant donors. Ovid Medline, Embase and Cochrane CENTRAL were searched up until January 2015. Data retrieved included the primary outcomes of 1‐year mortality, incidence of primary graft non‐function (PGNF) and retransplantation. Secondary outcomes included aspartate aminotransferase (AST) levels on day 3 post‐op. Pooled odds ratios (ORs) were calculated for dichotomous data and mean weighted ratios for continuous data. Ten studies included 593 patients (286 IPC; 307 control). IPC was associated with a reduction in mortality at 1 year (6% vs. 11%) although this was not statistically significant (OR 0.54, 95% C.I. 0.28–1.04, P = 0.06). The IPC group had a significantly lower day 3 AST level (WMD −66.41iU, P = 0.04). This meta‐analysis demonstrates that IPC reduces liver injury following transplantation and produces a large reduction in 1‐year mortality which was not statistically significant. Confirmation of clinical benefit from IPC requires an adequately powered prospective RCT.

Citation

Robertson, F. P., Magill, L. J., Wright, G. P., Fuller, B., & Davidson, B. R. (2016). A systematic review and meta-analysis of donor ischaemic preconditioning in liver transplantation. Transplant International, 29(11), 1147-1154. https://doi.org/10.1111/tri.12849

Journal Article Type Article
Acceptance Date Aug 17, 2016
Online Publication Date Sep 20, 2016
Publication Date 2016-11
Deposit Date Dec 11, 2018
Publicly Available Date Mar 29, 2024
Journal Transplant International
Print ISSN 0934-0874
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 29
Issue 11
Pages 1147-1154
DOI https://doi.org/10.1111/tri.12849
Keywords ischaemic preconditioning, ischaemic reperfusion injury, liver transplantation, morbidity, mortality
Public URL http://researchrepository.napier.ac.uk/Output/1432735

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