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A randomized trial of normothermic preservation in liver transplantation

Author

Listed:
  • David Nasralla

    (University of Oxford)

  • Constantin C. Coussios

    (University of Oxford)

  • Hynek Mergental

    (Queen Elizabeth Hospital Birmingham)

  • M. Zeeshan Akhtar

    (University of Oxford
    University of Oxford)

  • Andrew J. Butler

    (Addenbrooke’s Hospital)

  • Carlo D. L. Ceresa

    (University of Oxford)

  • Virginia Chiocchia

    (University of Oxford
    University of Oxford)

  • Susan J. Dutton

    (University of Oxford)

  • Juan Carlos García-Valdecasas

    (Hospital Clinic)

  • Nigel Heaton

    (King’s College Hospital)

  • Charles Imber

    (Royal Free Hospital)

  • Wayel Jassem

    (King’s College Hospital)

  • Ina Jochmans

    (University Hospitals Leuven
    KU Leuven)

  • John Karani

    (King’s College Hospital
    King’s College Hospital)

  • Simon R. Knight

    (University of Oxford
    Clinical Effectiveness Unit, Royal College of Surgeons of England)

  • Peri Kocabayoglu

    (Visceral and Transplantation Surgery, University Hospital Essen)

  • Massimo Malagò

    (Royal Free Hospital)

  • Darius Mirza

    (Queen Elizabeth Hospital Birmingham)

  • Peter J. Morris

    (University of Oxford
    Clinical Effectiveness Unit, Royal College of Surgeons of England)

  • Arvind Pallan

    (Queen Elizabeth Hospital Birmingham)

  • Andreas Paul

    (Visceral and Transplantation Surgery, University Hospital Essen)

  • Mihai Pavel

    (Hospital Clinic)

  • M. Thamara P. R. Perera

    (Queen Elizabeth Hospital Birmingham)

  • Jacques Pirenne

    (University Hospitals Leuven
    KU Leuven)

  • Reena Ravikumar

    (University of Oxford)

  • Leslie Russell

    (OrganOx Limited)

  • Sara Upponi

    (Addenbrooke’s Hospital)

  • Chris J. E. Watson

    (Addenbrooke’s Hospital
    Cambridge Biomedical Research Centre)

  • Annemarie Weissenbacher

    (University of Oxford)

  • Rutger J. Ploeg

    (University of Oxford)

  • Peter J. Friend

    (University of Oxford)

Abstract

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.

Suggested Citation

  • David Nasralla & Constantin C. Coussios & Hynek Mergental & M. Zeeshan Akhtar & Andrew J. Butler & Carlo D. L. Ceresa & Virginia Chiocchia & Susan J. Dutton & Juan Carlos García-Valdecasas & Nigel Hea, 2018. "A randomized trial of normothermic preservation in liver transplantation," Nature, Nature, vol. 557(7703), pages 50-56, May.
    • Handle: RePEc:nat:nature:v:557:y:2018:i:7703:d:10.1038_s41586-018-0047-9
    DOI: 10.1038/s41586-018-0047-9
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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. Shannon N. Tessier & Reinier J. de Vries & Casie A. Pendexter & Stephanie E. J. Cronin & Sinan Ozer & Ehab O. A. Hafiz & Siavash Raigani & Joao Paulo Oliveira-Costa & Benjamin T. Wilks & Manuela Loper, 2022. "Partial freezing of rat livers extends preservation time by 5-fold," Nature Communications, Nature, vol. 13(1), pages 1-13, December.
    4. C. Albert & L. Bracaglia & A. Koide & J. DiRito & T. Lysyy & L. Harkins & C. Edwards & O. Richfield & J. Grundler & K. Zhou & E. Denbaum & G. Ketavarapu & T. Hattori & S. Perincheri & J. Langford & A., 2022. "Monobody adapter for functional antibody display on nanoparticles for adaptable targeted delivery applications," Nature Communications, Nature, vol. 13(1), pages 1-13, December.
    5. Zonghu Han & Joseph Sushil Rao & Lakshya Gangwar & Bat-Erdene Namsrai & Jacqueline L. Pasek-Allen & Michael L. Etheridge & Susan M. Wolf & Timothy L. Pruett & John C. Bischof & Erik B. Finger, 2023. "Vitrification and nanowarming enable long-term organ cryopreservation and life-sustaining kidney transplantation in a rat model," Nature Communications, Nature, vol. 14(1), pages 1-12, December.

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