The 21st Congress of the European Society of Organ Transplantation (ESOT), held on September 17-20th, 2023, in Athens, Greece, was a pivotal event in transplantation, focusing on the theme ..."Disruptive Innovation, Trusted Care." The congress attracted a global audience of 2 826 participants from 82 countries, emphasizing its international significance. Machine perfusion, as a groundbreaking technology in organ transplantation, was one of the central focuses of the conference. This year's meeting had a remarkable increase in accepted abstracts on machine perfusion, evidencing its growing prominence in the field. The collective findings from these abstracts highlighted the efficacy of machine perfusion in improving organ viability and transplant outcomes. Studies demonstrated improvements in graft survival and reduction in complications, as well as novel uses and techniques. Furthermore, the integration of machine perfusion with regenerative medicine and its application across multiple organ types were significant discussion points. The congress also highlighted the challenges and solutions in implementing machine perfusion in clinical settings, emphasizing the importance of practical training and international collaboration for advancing this technology. ESOT 2023 served as a crucial platform for disseminating scientific advancements, fostering practical learning, and facilitating international collaborations in organ transplantation. The congress underscored the evolution and importance of machine perfusion technology, marking a significant step forward in enhancing patient outcomes in the field of organ transplantation.
Background
Recent evidence supports the use of machine perfusion technologies (MP) for marginal liver grafts. Their effect on enhanced recovery, however, remains uncertain.
Objectives
To identify ...areas in which MP might contribute to an ERAS program and to provide expert panel recommendations.
Data sources
Ovid MEDLINE, Embase, Scopus, Google Scholar, and Cochrane Central.
Methods
Systematic review and meta‐analysis following PRISMA guidelines and recommendations using the GRADE approach. CRD42021237713
Results
Both hypothermic (HMP) and normothermic (NMP) machine perfusion demonstrated significant benefits in preventing postreperfusion syndrome (PRS) (HMP OR .33, .15‐.75 CI; NMP OR .51, .29‐.90 CI) and early allograft dysfunction (EAD) (HMP OR .51, .35‐.75 CI; NMP OR .66, .45‐.97 CI), while shortening LOS (HMP MD ‐3.9; NMP MD ‐12.41). Only NMP showed a significant decrease in the length of ICU stay (L‐ICU) (MD ‐7.07, ‐8.76; ‐5.38 CI), while only HMP diminishes the likelihood of major complications. Normothermic regional perfusion (NRP) reduces EAD (OR .52, .38–.70 CI) and primary nonfunction (PNF) (OR .51, .27‐.98 CI) without effect on L‐ICU and LOS.
Conclusions
The use of HMP decreases PRS and EAD, specifically for marginal grafts. This is supported by a shorter LOS and a lower rate of major postoperative complications (QOE; moderate | Recommendation; Strong). NMP reduces the incidence of PRS and EAD with associated shortening in L‐ICU for both DBD and DCD grafts (QOE; moderate | Recommendation; High) This technology also shortens the length of hospital stay (QOE; low | Recommendation; Strong). NRP decreases the likelihood of EAD (QOE; moderate) and the risk of PNF (QOE; low) when compared to both DBD and SRR‐DCD grafts preserved in SCS. (Recommendation; Strong).
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