Journal Article

A randomized trial of normothermic preservation in liver transplantation

Upponi, Sara, Chiocchia, Virginia, Nasralla, David, García-Valdecasas, Juan Carlos, Friend, Peter J., Akhtar, M. Zeeshan, Ravikumar, Reena, Ceresa, Carlo D. L., Jochmans, Ina, Paul, Andreas, Butler, Andrew J., Russell, Leslie, Pirenne, Jacques, Kocabayoglu, Peri, Coussios, Constantin C., Perera, M. Thamara P. R., Mirza, Darius, Imber, Charles, Heaton, Nigel, Malagò, Massimo, Weissenbacher, Annemarie, Pavel, Mihai, Knight, Simon R., Watson, Chris J. E., Jassem, Wayel, Pallan, Arvind, Mergental, Hynek, Dutton, Susan J., Morris, Peter J., Karani, John, Ploeg, Rutger J.

2018

Overview

Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing. Here we show that, in a randomized trial with 220 liver transplantations, compared to conventional static cold storage, normothermic preservation is associated with a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time. There was no significant difference in bile duct complications, graft survival or survival of the patient. If translated to clinical practice, these results would have a major impact on liver transplant outcomes and waiting list mortality. Normothermic machine perfusion of the liver improved early graft function, demonstrated by reduced peak serum aspartate transaminase levels and early allograft dysfunction rates, and improved organ utilization and preservation times, although no differences were seen in graft or patient survival.

• Publisher: Nature Publishing Group UK,Nature Publishing Group
• Subject: 59/57 / 692/308/2779/777 / 692/308/575 / Adolescent / Adult / Aged / Aged, 80 and over / Allografts - pathology / Allografts - physiology / Allografts - physiopathology / Allografts - standards / Aspartate / Bile ducts / Bile Ducts - pathology / Bile Ducts - physiology / Bile Ducts - physiopathology / Blood & organ donations / Cold storage / Cryopreservation / Enzymes / Female / Functional testing / Graft Survival / Humanities and Social Sciences / Humans / Ischemia / Length of Stay / Liver / Liver - enzymology / Liver - physiology / Liver transplantation / Liver Transplantation - adverse effects / Liver Transplantation - methods / Liver transplants / Male / Methods / Middle Aged / Mortality / multidisciplinary / Organ Preservation - adverse effects / Organ Preservation - methods / Organ transplantation / Organs / Patients / Perfusion / Physiology / Recovery of function / Science / Science (multidisciplinary) / Surgery / Survival / Survival Analysis / Temperature / Tissue and Organ Harvesting - adverse effects / Tissue and Organ Harvesting - methods / Tissue Donors - supply & distribution / Transplantation / Treatment Outcome / Viability / Waiting Lists / Young Adult