Liver perfusion could save 7 in 10 rejected donor livers

Date:
June 17, 2020
Source:
University of Birmingham
Summary:
A major study investigating the effectiveness of liver perfusion
as a technique to improve the function of donor livers that would
have otherwise been rejected has shown that up to 7 in every 10
could be used after just 4-6 hours of the assessment.



FULL STORY ==========================================================================
A major study investigating the effectiveness of liver perfusion as
a technique to improve the function of donor livers that would have
otherwise been rejected has shown that up to 7 in every 10 could be used
after just 4-6 hours of the assessment.


==========================================================================
The study, 'Transplantation of discarded livers following viability
testing with normothermic machine perfusion', published today in
Nature Communications, could have significant implications for the
liver transplant waiting list and the commissioning of local transplant services.

Currently, across the UK, a third of donated livers don't meet desired transplant criteria and aren't used. Chronic liver disease in the UK
is rising annually, a result of obesity and increasing alcohol misuse
causing approximately 8500 deaths per year. For those with end-stage liver disease, a transplant is the only hope for survival, but demand for livers suitable for transplantation far outstrips supply. According to the latest
NHS Blood and Transplant report, up to 20% of people awaiting a transplant operation died or were removed from waiting lists due to ill health.

A growing proportion of donated livers are coming from high-risk
donors with a history of alcohol misuse, obesity or elderly people
with comorbidities, often when a patient has suffered cardiac arrest
that is unexpected and when the patient cannot or should not be
resuscitated. These livers are of lower quality and pose risks to
recipients. Consequently, the majority are not transplanted.

Funded by the Wellcome Trust, experts from the University of Birmingham's Centre for Liver and Gastrointestinal Research, University Hospitals
Birmingham NHS Foundation Trust and the NIHR Birmingham Biomedical
Research Centre have found that just 4-6 hours of normothermic machine perfusion assessment enabled 70 per cent of currently discarded livers
to recover enough to allow successful transplantation into a recipient.

Mr Hynek Mergental, Honorary Senior Lecturer at the University of
Birmingham and Consultant Surgeon at the UHB Liver Unit said: "Whilst
liver transplantation is one of the most advanced surgical procedures,
up to now, there has been no objective mean to assess suitability
of donor livers for transplantation. The VITTAL trial validated our pre-clinical research and pilot clinical observations and these viability criteria can now guide transplant teams worldwide to provide access
to the life-saving transplantation to more patients in need. " VITTAL
project lead, Professor Darius Mirza, Consultant Transplant Surgeon
at University Hospitals Birmingham NHS Foundation Trust, added: "This challenging study was designed to assess function of discarded livers in
the real-life situation, using the normothermic machine perfusion. The
major challenge in this pioneering clinical trial was to assure patients
safety while pushing the envelope of sub-optimal liver utilisation."
Mr Thamara Perera, Consultant Transplant Surgeon at UHB explains: "This
ground breaking trial has proven that objective parameters can be used
for making a decision to use a borderline liver. The observed 100% study participants post- transplant survival was reassuring and provided our
patients and the surgical team with confidence to implement and further
expand this approach, which now helps the sickest patients on our waiting
list to underwent transplantation sooner and safer." Dr Simon Afford,
Reader in Liver Immunobiology at the of the University of Birmingham's Institute of Immunology and Immunotherapy, said: "It has long been
recognised that as a consequence of our population aging the quality of
donated livers keeps declining. Based on our latest discoveries we believe
that in the near future the machine perfusion platform will facilitate therapeutic interventions to improve liver viability. We expect we will
be able salvage even more organs than 70% observed in the VITTAL trial, including livers from donors with known alcohol misuse or obesity."
Tim Knott, Head of Innovation Programmes at the Wellcome Trust, said:
"Many more patients who need liver transplants will benefit from this technology.

Giving surgeons the tools to assess if a liver transplant will
be viable will help the thousands of people who have chronic liver
disease globally." John Forsythe, Medical Director of Organ Donation
and Transplantation for NHS Blood and Transplant, said: "New techniques
of Organ perfusion and preservation are a vital developing area of organ donation and transplantation. We are delighted that a number of doctors
and scientists in the UK are leading the way in this field of research.

"Each year a small number of donated organs are not transplanted for a
variety of reasons. Transplant success relies on a significant amount
of activity taking place in a short space of time. New techniques are
already allowing us to transplant donated organs that would not have
been possible in the past.

More research in this area is likely to increase that ability."

========================================================================== Story Source: Materials provided by University_of_Birmingham. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. 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. Hu"bscher,
Paolo Muiesan, John R. Isaac, Keith J. Roberts, Manuel Abradelo,
Andrea Schlegel, James Ferguson, Hentie Cilliers, Julian Bion,
David H. Adams, Chris Morris, Peter J. Friend, Christina Yap,
Simon C. Afford, Darius F. Mirza.

Transplantation of discarded livers following viability testing
with normothermic machine perfusion. Nature Communications, 2020;
11 (1) DOI: 10.1038/s41467-020-16251-3 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2020/06/200617102441.htm

--- up 21 weeks, 1 day, 2 hours, 34 minutes
* Origin: -=> Castle Rock BBS <=- Now Husky HPT Powered! (1337:3/111)