Substantial decline of organ preservation fluid contamination following adoption of ischemia-free liver transplantation: a post-hoc analysis.
Lin, J., et al.International Journal of Surgery 2024; 110(5): 2855-2864.
Aims
This post-hoc analysis of a randomised controlled trial aimed to investigate whether ischaemia-free liver transplantation (IFLT) led to a reduction in preservation fluid (PF) contamination.
Interventions
Participants in the original trial were randomly assigned to either IFLT or conventional liver transplantation (CLT).
Participants
64 patients with end-stage liver disease.
Outcomes
The main outcomes of interest included prevalence of PF contamination, microbiology of PF samples in IFLT and CLT, risk factors associated with culture-positive PF and recipient infection within 14 days postoperatively.
Follow-up
14 days
CET Conclusions
Ischaemia-free liver transplantation (IFLT) is a novel technique which employs normothermic machine perfusion prior to organ retrieval and continues it until transplantation. This post-hoc analysis of a trial that compared the safety and efficacy of IFLT to conventional liver transplantation (CLT), focused on comparing the rate of infection found in the perfusion fluid (PF) between IFLT and CLT and assessing the clinical impact of these infections. 64 livers were randomised equally between the two groups, with a PF infection rate of 9.4% in the IFLT group versus 78.1% in the CLT group. The rate of infective complications in the recipients by day 14 was, although numerically higher in the CLT group, not statistically significant. The authors assert that the sterile technique used in IFLT is superior to CLT. However, a major confounder is the difference of antibiotic protocols used in the groups – the broader spectrum imipenem/cilastin was used in the IFLT versus gentamycin in the CLT. In the literature, the rate of PF infection is reported as generally high, but with low rates of clinically relevant sequelae in recipients. This likely accounts for the lack of effect demonstrated in this study.
Trial registration
ChiCTR1900021158