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

Robertson, FP; Magill, LJ; Wright, GP; Fuller, B; Davidson, BR; (2016) A systematic review and meta-analysis of donor ischaemic preconditioning in liver transplantation. Transplant International , 29 (11) pp. 1147-1154. 10.1111/tri.12849. Green open access

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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.

Type: Article
Title: A systematic review and meta-analysis of donor ischaemic preconditioning in liver transplantation.
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1111/tri.12849
Publisher version: http://dx.doi.org/10.1111/tri.12849
Language: English
Additional information: Copyright © 2016 Steunstichting ESOT. This is the peer reviewed version of the following article: [Robertson, F. P., Magill, L. J., Wright, G. P., Fuller, B. and Davidson, B. R. (2016), A systematic review and meta-analysis of donor ischaemic preconditioning in liver transplantation. Transplant International, 29: 1147–1154. doi: 10.1111/tri.12849], which has been published in final form at http://dx.doi.org/10.1111/tri.12849. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving.
Keywords: ischaemic preconditioning, ischaemic reperfusion injury, liver transplantation, morbidity, mortality
UCL classification: UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Medical Sciences > Div of Surgery and Interventional Sci > Department of Surgical Biotechnology
URI: https://discovery.ucl.ac.uk/id/eprint/1515847
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