title: Preservation solutions for liver transplantation in adults: celsior versus custodiol: a systematic review and meta-analysis with an indirect comparison of randomized trials.
abstract: BACKGROUND
  The University of Wisconsin (UW) solution has been recognized as the gold standard for liver preservation; however, it possesses some limitations, and other solutions exist for organ preservation. The aim of this study was to compare the liver functions of transplanted grafts that had been stored in Celsior and Custodiol solutions.
  
  
  METHODS
  We searched the MEDLINE, EMBASE, LILACS, Cochrane Central Register of Controlled Trials, and SCIELO databases. We included randomized and quasi-randomized, controlled trials that compared the efficacy and safety of Celsior and Custodiol with UW solution for liver preservation in adults. The factors that were considered for analysis were their impacts on primary dysfunction (primary nonfunction and initial poor function), ischemic-type biliary lesions, and patient and graft survival rates. Because of the lack of direct evidence, an indirect comparison of Celsior and Custodiol was calculated.
  
  
  RESULTS
  We identified 3 randomized controlled trials and 1 quasi-randomized, controlled trial to pool in a meta-analysis of Celsior versus UW solutions. The number of episodes of primary dysfunction was lower in the Celsior group (7.4%) than in the UW group (9.8%), but the difference was not significant (relative risk [RR], 0.68; 95% confidence interval [CI], 0.22-1.97). Two randomized controlled trials compared Custodiol and Wisconsin solutions were identified. The number of episodes of primary dysfunction was also lower in the Custodiol group (3.0%) compared with the Wisconsin group (8.4%), but the difference was not significant (RR, 0.36; 95% CI, 0.08-1.70). An indirect comparison using data from the main analysis revealed no difference between the Celsior and Custodiol solutions (RR, 1.88; 95% CI, 0.57-6.16).
  
  
  CONCLUSIONS
  The Celsior and Custodiol solutions performed similarly to UW solution as preservation solutions in liver transplantation clinical settings.
authors.affiliation: Epidemiology Academic Group (GRAEPIC), Universidad de Antioquia, Medellín-Colombia.
authors.forename: G L
authors.initials: GL
authors.lastname: Lema Zuluaga
authors.forename: R E
authors.initials: RE
authors.lastname: Serna Agudelo
authors.forename: J J
authors.initials: JJ
authors.lastname: Zuleta Tobón
mesh_terms: D004187:Disaccharides / Q000494:pharmacology; D004573:Electrolytes / Q000494:pharmacology; D005947:Glucose / Q000494:pharmacology; D005971:Glutamates / Q000494:pharmacology; D005978:Glutathione / Q000494:pharmacology; D006085:Graft Survival; D006639:Histidine / Q000494:pharmacology; D006801:Humans; D017093:Liver Failure / Q000401:mortality / Q000601:surgery; D016031:Liver Transplantation / Q000379:methods*; D008353:Mannitol / Q000494:pharmacology; D009926:Organ Preservation / Q000379:methods*; D019188:Organ Preservation Solutions / Q000494:pharmacology*; D011189:Potassium Chloride / Q000494:pharmacology; D011343:Procaine / Q000494:pharmacology; D016032:Randomized Controlled Trials as Topic; D012306:Risk; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: C039984:Bretschneider cardioplegic solution; C088453:Celsior; D004187:Disaccharides; D004573:Electrolytes; D005971:Glutamates; D019188:Organ Preservation Solutions; D008353:Mannitol; D006639:Histidine; D011343:Procaine; D011189:Potassium Chloride; D005978:Glutathione; D005947:Glucose