The technique could significantly increase the number of livers available for transplant
“It’s exciting to try and rescue the organs that aren’t used, or the ones with problems that could be used. This liver was totally amazing.” Pierre-Alain Clavien, professor of surgery, University of Zurich
A patient who received a donated liver remains healthy one year on from surgery.
Nothing unusual about that – except the liver had been stored for three days in a new type of machine that mimics the human body. The authors of a new study in Nature Biotechnology say that the technology could enable donor livers to be preserved for longer than the current 12-hour maximum. It could also make it possible to repair livers that are available but too damaged to transplant – resulting in a significant increase in the number of donor livers available.
The study was carried out by a team University Hospital Zurich, led by Pierre-Alain Clavien, a professor of surgery. They used a donor liver which belonged to a 29-year old woman and had been rejected by all other transplant centres because of a lesion. Examining the lesion to determine whether it was benign would have taken 24 hours – well outside the maximum window.
The researchers stored the liver in a machine that has the same temperature as the human body (37 °C) and similar levels of pressure. Doing this gave the doctors extra time, enabling them to carry out the biopsy. The machine flushed out the liquid remaining inside the liver and monitored bile and protein production. It also used antibiotics and an antifungal drug to treat an infection that would normally mean the liver couldn’t be used for transplant.
Once a liver has been removed from a donor, it is usually stored on ice for no more than 12 hours to prevent the cells from being damaged by the cold, something that would reduce the likelihood of a successful transplant. Because the time window is so narrow, it can be hard to match organs to people needing a donor liver, meaning many patients die before one can be found.
The patient in this study “rapidly recovered a normal quality of life without any signs of liver damage, such as rejection or injury to the bile ducts, according to a 1-year follow up,” the Nature Biotechnology report says.
Noting that in the US, 70% of donor livers are not used, Clavien said: “Whether we can rescue that 70%, I don’t know. But it’s exciting to try and rescue the organs that aren’t used, or the ones with problems that could be used. This liver was totally amazing.”
The team thinks it’s possible that the new technique could allow donor livers to be stored safely for up to 12 days before transplantation, as well as increasing the likelihood of being able to treat donor livers with drugs before surgery.
Finding suitable organs for transplant is a longstanding problem, and many patients die while waiting. Currently, more than 6,000 people are waiting for an organ transplant, yet in the UK, about a third of livers don’t meet the criteria for transplant and are rejected. This study shows that many of those livers could be saved and used, offering hope to the many people suffering from chronic liver disease who are in desperate need of a transplant.
Such technical advances can be transformational and it is crucial to ensure reliable, safe techniques are properly tested and can progress to clinical practice rapidly