UW和HTK器官保存液对移植供肝保存效果及术后结局影响的Meta分析

Storage effect and transplant outcomes of University of Wisconsin preservation solution and histidine- tryptophan-ketoglutarate preservation solution on liver allografts： a Meta-analysis

目的系统评价UW和HTK器官保存液（简称UW液和HTK液）在肝移植术中对移植肝保存效果及术后结局的影响。方法以organ preservation, storage solutions, Histidine-tryptophan-ketoglutarate,HTK ,custodial, bretschneider, University of Wisconsin, UW solution, viaspan, cardiosol, belzer solution, hepatic transplantation, liver transplantation, viscera transplantation, liver grafts, hepatic grafts, liver allografts, hepatic allografts、万方数据库、维普数据库。检索时间为建库至2015年10月。纳入比较uw液和HTK液在肝移植术中对移植肝的保存效果的研究，再由2名文献评价员独立筛查文献和提取数据，并进行文献质量评价。在肝移植术中采用UW液设为UW组，采用HTK液设为HTK组。计数资料采用比值比（OR）为效应统计分析指标，计量资料采用标准均数差（SMD）及95％可信区间（95％CI）表示。采用χ^2检验对各研究结果间的异质性进行分析，I^2对异质性进行分析。结果共纳入符合纳入标准的11篇。累计样本量34475例，其中UW组25248例，HTK组9227例。Meta分析结果显示：UW组和HTK组受者原发性移植肝无功能，再移植发生率，受者及移植肝1年总体生存率，差异均无统计学意义（OR=1．18，0．84，0．97，1．02，95％CI：0．55-2．57，0．47-1．50，0．66-1．42，0．66-1．58，P〉0．05）。UW组和HTK组受者术后第1天肝功能相关指标ALT，AST，TBil比较，差异均无统计学意义（SMD=-0．19，-0．30，0．30，95％CI：-0．62-0．23，-0．70-0．10，-0．01-0．61，P〉0．05）；UW组和HTK组受者术后PT和ALP比较，差异均无统计学意义（P〉0．05）。uw组和HTK组受者术后胆道并发症发生率比较，差异无统计学意义（OR=1．49，95％CI，0．97-2．30，P〉0．05）。结论uw液和HTK液对移植供肝的保存效果一致，两种器官保存液对受者预后结局的影响无明显优劣。

Objective To systematically evaluate the storage effect and transplant outcomes of University of Wisconsin （UW） preservation solution and histidine-tryptophan-ketoglutarate （HTK） preservation solution on liver allografts. Methods Literatures were researched using PubMed, Embase （1980-） , Ovid Medline （1948-） , The Cochrane Library, Wanfang database, VIP database from the database establishement to October 2015 with the key words including organ preservation, storage solutions, Histidine-tryptophan-ketoglutarate or HTK, custodial, bretschneider, University of Wisconsin, UW solution, viaspan, cardiosol, belzer solution, hepatic transplantation, liver transplantation, viscera transplantation, liver grafts, hepatic grafts, liver allografts, hepatic allografts, 器官移植, 器官保存液,UW, HTK, 肝移植 and 比较. Two reviewers independently screened literatures, extracted data and assessed the risk of bias. All the patients using UW and HTK preservation solutions were respectively allocated into the UW group and HTK group. Count data were represented as the odds ratio （OR） and measurement data were represented as the standardized mean difference （SMD） and 95% confidence interval （CI）. The heterogeneity of the studies was analyzed using the I^2 test. Results Eleven literatures were retrieved,and the total sample size were 34 475 patients including 25 248 in the UW group and 9 227 in the HTK group. The results of Meta analysis showed that there were no statistically significant differences in the primary transplants nonfunetion, retransplant rate and 5-year grafts overall survival rate between the 2 groups （ OR = 1. 18, 0. 84, 0. 97, 1.02, 95% CI： 0. 55-2. 57, 0. 47-5.50, 0. 66-1.42, 0. 66-1.58, P 〉 0.05）. There were also no statistically significant differences in the levels of alanine transaminase （ALT）, aspartate transaminase （AST）, total bilirubin （TBil） at postoperative day 5 between the 2 groups （SMD =- 0. 59, -0. 30, 0. 30, 95% CI： -0. 62-0. 23, -0. 70-0. 50, -0. 01-0. 61, P 〉 0.05）. There were no statistically significant differences in the postoperative prothrombin time（PT） and alkaline phosphatase（ALP） between the 2 groups （P 〉 0.05 ） and in the incidence of postoperative biliary complications between the 2 groups （ OR = 5.49, 95% CI： 0. 97-2. 30, P 〉 0.05）. Conclusion There is similar storage effect between UW and HTK preservation solutions on liver allografts, and no difference in the transplant outcomes.