1. Machine Perfusions in Liver Transplantation: The Evidence‐Based Position Paper of the Italian Society of Organ and Tissue Transplantation
- Author
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Paolo Muiesan, Massimo Rossi, Damiano Patrono, F. Melandro, Daniele Pezzati, Markus Selzner, Alberto Zanella, Andrea Lauterio, Riccardo De Carlis, Cristiano Quintini, Stefano Baroni, Domenico Bassi, Davide Ghinolfi, Paolo Magistri, Fabio Ferla, Luca Toti, Marinella Zanierato, Matteo Ravaioli, Quirino Lai, Chiara Lazzeri, Wayel Jassem, Patrizia Burra, Daniele Dondossola, Duilio Pagano, Philippe Dutkowski, Umberto Cillo, Erion Rreka, Salvatore Petta, University of Zurich, Ghinolfi, Davide, Ghinolfi, D, Lai, Q, Dondossola, D, De Carlis, R, Zanierato, M, Patrono, D, Baroni, S, Bassi, D, Ferla, F, Lauterio, A, Lazzeri, C, Magistri, P, Melandro, F, Pagano, D, Pezzati, D, Ravaioli, M, Rreka, E, Toti, L, Zanella, A, Burra, P, Petta, S, Rossi, M, Dutkowski, P, Jassem, W, Muiesan, P, Quintini, C, Selzner, M, Cillo, U, Ghinolfi D., Lai Q., Dondossola D., De Carlis R., Zanierato M., Patrono D., Baroni S., Bassi D., Ferla F., Lauterio A., Lazzeri C., Magistri P., Melandro F., Pagano D., Pezzati D., Ravaioli M., Rreka E., Toti L., Zanella A., Burra P., Petta S., Rossi M., Dutkowski P., Jassem W., Muiesan P., Quintini C., Selzner M., and Cillo U.
- Subjects
medicine.medical_specialty ,Evidence-based practice ,2747 Transplantation ,GRADE ,donor after circulatory death ,donor brain death ,hypothermic machine ,liver transplant ,machine perfusion ,normothermic machine ,normothermic regional perfusion ,position paper ,medicine.medical_treatment ,Delphi method ,MEDLINE ,610 Medicine & health ,liver, perfusion machine ,030230 surgery ,Liver transplantation ,liver ,03 medical and health sciences ,0302 clinical medicine ,Humans ,Medicine ,Medical physics ,10217 Clinic for Visceral and Transplantation Surgery ,HumansItaly ,Transplantation ,Machine perfusion ,Hepatology ,business.industry ,Organ Preservation ,perfusion machine ,Institutional review board ,Liver Transplantation ,2746 Surgery ,Perfusion ,Italy ,Position paper ,2721 Hepatology ,030211 gastroenterology & hepatology ,Surgery ,business ,Human - Abstract
The use of machine perfusion (MP) in liver transplantation (LT) is spreading worldwide. However, its efficacy has not been demonstrated, and its proper clinical use has far to go to be widely implemented. The Società Italiana Trapianti d’Organo (SITO) promoted the development of an evidence-based position paper. A 3-step approach has been adopted to develop this position paper. First, SITO appointed a chair and a cochair who then assembled a working group with specific experience of MP in LT. The Guideline Development Group framed the clinical questions into a patient, intervention, control, and outcome (PICO) format, extracted and analyzed the available literature, ranked the quality of the evidence, and prepared and graded the recommendations. Recommendations were then discussed by all the members of the SITO and were voted on via the Delphi method by an institutional review board. Finally, they were evaluated and scored by a panel of external reviewers. All available literature was analyzed, and its quality was ranked. A total of 18 recommendations regarding the use and the efficacy of ex situ hypothermic and normothermic machine perfusion and sequential normothermic regional perfusion and ex situ MP were prepared and graded according to the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) method. A critical and scientific approach is required for the safe implementation of this new technology.
- Published
- 2020
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