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Transplantation of discarded livers following viability testing with normothermic machine perfusion

Author

Listed:
  • Hynek Mergental

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT)
    University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham)

  • Richard W. Laing

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT)
    University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham)

  • Amanda J. Kirkham

    (University of Birmingham)

  • M. Thamara P. R. Perera

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT))

  • Yuri L. Boteon

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT)
    University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham)

  • Joseph Attard

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT)
    University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham)

  • Darren Barton

    (University of Birmingham)

  • Stuart Curbishley

    (University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham)

  • Manpreet Wilkhu

    (University of Birmingham)

  • Desley A. H. Neil

    (University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham
    University Hospitals Birmingham NHS Foundation Trust (UHBFT))

  • Stefan G. Hübscher

    (University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham
    University Hospitals Birmingham NHS Foundation Trust (UHBFT))

  • Paolo Muiesan

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT))

  • John R. Isaac

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT))

  • Keith J. Roberts

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT)
    University of Birmingham)

  • Manuel Abradelo

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT))

  • Andrea Schlegel

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT)
    University of Birmingham)

  • James Ferguson

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT)
    University of Birmingham and University Hospitals Birmingham NHS Foundation Trust)

  • Hentie Cilliers

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT))

  • Julian Bion

    (University of Birmingham)

  • David H. Adams

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT)
    University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham)

  • Chris Morris

    (OrganOx Limited)

  • Peter J. Friend

    (OrganOx Limited
    University of Oxford)

  • Christina Yap

    (University of Birmingham
    The Institute of Cancer Research)

  • Simon C. Afford

    (University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham)

  • Darius F. Mirza

    (University Hospitals Birmingham NHS Foundation Trust (UHBFT)
    University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
    University of Birmingham)

Abstract

There is a limited access to liver transplantation, however, many organs are discarded based on subjective assessment only. Here we report the VITTAL clinical trial (ClinicalTrials.gov number NCT02740608) outcomes, using normothermic machine perfusion (NMP) to objectively assess livers discarded by all UK centres meeting specific high-risk criteria. Thirty-one livers were enroled and assessed by viability criteria based on the lactate clearance to levels ≤2.5 mmol/L within 4 h. The viability was achieved by 22 (71%) organs, that were transplanted after a median preservation time of 18 h, with 100% 90-day survival. During the median follow up of 542 days, 4 (18%) patients developed biliary strictures requiring re-transplantation. This trial demonstrates that viability testing with NMP is feasible and in this study enabled successful transplantation of 71% of discarded livers, with 100% 90-day patient and graft survival; it does not seem to prevent non-anastomotic biliary strictures in livers donated after circulatory death with prolonged warm ischaemia.

Suggested Citation

  • Hynek Mergental & Richard W. Laing & Amanda J. Kirkham & M. Thamara P. R. Perera & Yuri L. Boteon & Joseph Attard & Darren Barton & Stuart Curbishley & Manpreet Wilkhu & Desley A. H. Neil & Stefan G. , 2020. "Transplantation of discarded livers following viability testing with normothermic machine perfusion," Nature Communications, Nature, vol. 11(1), pages 1-12, December.
    • Handle: RePEc:nat:natcom:v:11:y:2020:i:1:d:10.1038_s41467-020-16251-3
    DOI: 10.1038/s41467-020-16251-3
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    Cited by:

    1. Adam M. Thorne & Justina C. Wolters & Bianca Lascaris & Silke B. Bodewes & Veerle A. Lantinga & Otto B. Leeuwen & Iris E. M. Jong & Kirill Ustyantsev & Eugene Berezikov & Ton Lisman & Folkert Kuipers , 2023. "Bile proteome reveals biliary regeneration during normothermic preservation of human donor livers," Nature Communications, Nature, vol. 14(1), pages 1-13, December.
    2. T. Hautz & S. Salcher & M. Fodor & G. Sturm & S. Ebner & A. Mair & M. Trebo & G. Untergasser & S. Sopper & B. Cardini & A. Martowicz & J. Hofmann & S. Daum & M. Kalb & T. Resch & F. Krendl & A. Weisse, 2023. "Immune cell dynamics deconvoluted by single-cell RNA sequencing in normothermic machine perfusion of the liver," Nature Communications, Nature, vol. 14(1), pages 1-18, December.
    3. Linda Große-Segerath & Paula Follert & Kristina Behnke & Julia Ettich & Tobias Buschmann & Philip Kirschner & Sonja Hartwig & Stefan Lehr & Mortimer Korf-Klingebiel & Daniel Eberhard & Nadja Lehwald-T, 2024. "Identification of myeloid-derived growth factor as a mechanically-induced, growth-promoting angiocrine signal for human hepatocytes," Nature Communications, Nature, vol. 15(1), pages 1-15, December.
    4. Marti Cabanes-Creus & Sophia H. Y. Liao & Renina Gale Navarro & Maddison Knight & Deborah Nazareth & Ngee-Soon Lau & Mark Ly & Erhua Zhu & Ramon Roca-Pinilla & Ricardo Bugallo Delgado & Ana F. Vicente, 2024. "Harnessing whole human liver ex situ normothermic perfusion for preclinical AAV vector evaluation," Nature Communications, Nature, vol. 15(1), pages 1-15, December.
    5. Marlon J. A. Haan & Marleen E. Jacobs & Franca M. R. Witjas & Annemarie M. A. Graaf & Elena Sánchez-López & Sarantos Kostidis & Martin Giera & Francisco Calderon Novoa & Tunpang Chu & Markus Selzner &, 2024. "A cell-free nutrient-supplemented perfusate allows four-day ex vivo metabolic preservation of human kidneys," Nature Communications, Nature, vol. 15(1), pages 1-15, December.

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