Early Clinical Results Using Normothermic Machine Liver Preservation

Abstract

The ongoing shortage of donor organs for liver transplantation results in high mortality rates for those on the waiting list. This has triggered considerable interest in the use of marginal liver grafts to increase the donor pool. Unfortunately, marginal grafts poorly tolerate preservation by cold storage (CS), resulting in an increased risk of liver injury and poor graft function after transplantation. Better preservation techniques are needed to fully utilize marginal grafts and to expand the number of organ donors. Animal studies have demonstrated normothermic ex vivo liver perfusion to be superior to conventional CS. Recently, the first clinical trial of normothermic ex vivo liver perfusion was completed with promising results. Similarly, in situ recirculation after cardiac arrest as the initial preservation method before organ procurement has proven to be a valuable technique to make more liver grafts available for transplantation. Though technically more complex and economically more expensive, normothermic liver perfusion is a promising and innovative technique that is able to positively impact current transplant practice and outcomes.

Subnormothermic ex vivo liver perfusion is a safe alternative to cold static storage for preserving standard criteria grafts

“…SNEVLP offers a unique opportunity as a protective strategy against preservation/reperfusion injury before liver transplantation. The advantages of warm machine perfusion over conventional CS have been reviewed extensively before . Future protective strategies might include deliveries of radical scavenging molecules (eg, N ‐acetylcysteine or tocopherol), or protective enzymes like hemoxigenase‐1, or H 2 S during SNEVLP .…”

“…Previous research has focused mostly on improving liver preservation of marginal grafts. We and others have demonstrated that (sub)normothermic ex vivo liver perfusion reduces liver and bile duct injury in grafts harvested by donation after cardiac death (DCD) and fatty livers . Improving organ preservation in marginal grafts has the potential to increase the donor pool and improve graft function after liver transplantation.…”