Donor ischaemic preconditioning in liver transplantation: A systematic review and meta-analysis

Objective To systematically review the effect of donor ischaemic preconditioning in liver transplantation. Methods Databases including the Cochrane Library, PubMed, EMbase, CNKI, VIP and WanFang database were searched up to June 2016 for studies which involved donor ischaemic preconditioning (IPC) in liver transplantation. The data retrieved included 1-year mortality, incidence of Primary Graft Non-Functioning (PGNF), intensive therapy unit (ICU) hospitalization and liver function tests which were used to evaluate the treatment outcomes. The data were analyzed using both the fixed-effect and the random-effects models. For categorical outcomes, risk ratio (RR) with 95% confidence intervals (CI) were calculated. For continuous outcomes, the mean difference (MD) with 95% CI were calculated. The meta-analysis was performed using Review Manager 5.2 software. Results Six clinical studies with 322 patients were qualified for this meta-analysis. There were no significant differences in the 1-year mortality (OR=0.51, 95%CI 0.24~1.05, P>0.05), PGNF (OR=0.33, 95%CI 0.08~1.40, P>0.05) and ICU hospitalization (OR=-0.17, 95%CI -2.72~2.38, P>0.05) between the donor ischaemic preconditioning and the control groups. There were also no significant differences in the transaminase and bilirubin levels on postoperative day 1, 3 and 7 between the two groups. Conclusion There is currently not enough evidence in evidenced based medicine to recommend the routine use of ischaemic preconditioning in donor liver retrieval. Key words: Ischaemic preconditioning; Liver transplantation; Donor