UW与HTK保存液在肝脏移植术中临床效果对比的系统评价和meta分析

目的比较肝脏移植术中两种常用的器官保存液(UW液与HTK液)的临床效果。方法全面检索PubMed、Embase、Cochrane Library、中国期刊全文数据库、中国生物医学文献数据库、万方、维普等中英文数据库,纳入对比UW(UW液组)与HTK(HTK液组)两种保存液对移植肝脏保存效果的研究,提取资料并评价后用RevMan 5.3软件进行分析。结果最终纳入16篇文献共35 024例受者,meta分析结果显示,与UW液组比较,HTK液组的术后胆管并发症发生率[RR=1.30,95%CI(1.07,1.58),P=0.008]和术后7 d内天门冬氨酸氨基转移酶峰值[MD=112.45,95%CI(93.34,131.56),P<0.01]均较低,而术后移植肝原发性无功能发生率[RR=1.07,95%CI(0.52,2.18),P=0.86]、术后不同时间点移植肝和受者存活率(P>0.05)、术后再移植率[RR=0.83,95%CI(0.48,1.45),P=0.51]、急性排斥反应发生率[RR=1.27,95%CI(0.96,1.68),P=0.33]、7 d内丙氨酸氨基转移酶峰值[MD=31.79,95%CI(–161.84,225.42),P=0.75]、总胆红素水平[MD=19.42,95%CI(–10.83,49.67),P=0.21]、凝血酶原时间[MD=1.75,95%CI(0.01,3.49),P=0.838]等指标比较差异均无统计学意义。结论 HTK保存液对移植肝的保存安全且有效,具有与UW保存液相似的效果,关于二者对肝移植术后受者和移植肝远期存活率的影响仍需要大样本、高质量的随机对照试验研究来系统评价。

Clinical effect of histidine-tryptophan-ketoglutarate solution versus University of Wisconsin solution for liver transplantation: a systematic review and meta-analysis

Objective To compare the clinical effects of two commonly used organ preservation solutions University of Wisconsin(UW) solution and histidine-tryptophan-ketoglutarate(HTK) solution in liver transplantation.Methods The PubMed,Embase,Cochrane Library,CNKI,CBM,VIP,and Wanfang Data were searched to collect the comparative studies of the UW solution and HTK solution in the liver transplantation. The data were extracted and evaluated by the RevMan 5.3 software. Results Finally,16 articles with a total of 35 024 patients were included. The meta-analysis results showed that the HTK solution group had a lower incidence of postoperative biliary complications[RR=1.30,95%CI(1.07 1.58),P=0.008] and lower aspartate aminotransferase peak level within 7 d after operation[MD=112.45,95%CI(93.34,131.56),P<0.01] as compared with the UW solution group. No significant differences were found in terms of the incidence of primary non-function [RR=1.07,95%CI(0.52,2.18),P=0.86],survival rates of patient and graft in different time points(P>0.05),incidence of retransplantation [RR=0.83,95%CI(0.48,1.45),P=0.51],incidence of acute rejection [RR=1.27,95%CI(0.96,1.68),P=0.33],alanine aminotransferase peak level within 7 d[MD=31.79,95%CI(–161.84,225.42),P=0.75] after operation,total bilirubin [MD=19.42,95%CI(–10.83,49.67),P=0.21],and prothrombin time [MD=1.75,95%CI(0.01,3.49),P=0.84] between these two groups. Conclusions HTK solution is safe and effective for liver transplantation,and has similar effects as UW solution. Regarding effect of both on long-term survival rates of patient and graft,large-sample and high-quality RCT is still needed for systematic evaluation.