A new storage technique could vastly expand the number of livers available for transplant
A patient who received a donated liver that had been stored for three days in a new type of machine that mimics the human body is healthy one year on from surgery, according to a study in Nature Biotechnology. The technology could dramatically increase the number of transplantable livers, according to the authors. It allows donor livers to be preserved longer than the current standard, and also makes it possible to repair organs that are not suitable for transplant.
A team from University Hospital Zurich, led by Pierre-Alain Clavien, a professor at the Department of Surgery, stored the liver in a machine that re-creates some of the conditions inside the human body: similar levels of pressure, and a temperature of 37 degC. The machine removed any liquid from the liver and monitored the production of bile and protein. The machine also provided antibiotics and an antifungal medication to the liver to treat an infection that would ordinarily prevent it from being donated.
The donor liver, which belonged to a 29-year-old woman, had been rejected by all other transplant centers because it had a lesion. Examining the lesion to determine whether it was benign would have taken 24 hours, longer than the current maximum window between donation and transplantation. The study provided doctors with the opportunity to perform a biopsy and treat the lesion successfully. This technique could be used to transplant livers from other patients with similar issues, potentially saving many lives.
“In the US, 70% of [donor livers] are not used. Whether we can rescue that 70%, I don’t know,” Clavien says. It’s thrilling to rescue organs that aren’t being used or those with potential problems. This liver was totally amazing.”
Once removed from their donor, livers are usually stored on ice for a maximum of 12 hours to prevent the cells from being damaged by the cold, which would decrease the chances of a successful transplant. This narrow window makes it difficult for organ donors to match patients who need them. Many patients die before they can find a donor.
Although further research is required, the team believes the new technique could allow donor livers to be stored safely for up to 12 days before transplantation. It could increase the chances of treating donor livers with drugs prior to surgery if it works.
The 62-year-old male recipient had several serious liver conditions, including advanced cirrhosis and severe portal hypertension–an increase in the blood pressure in a major blood vessel that carries blood from the bowel and spleen to the liver.
The liver functioned normally within three days after it was transplanted into the patient’s body. The patient took immunosuppressants to ward off the risk of infection post-surgery and was discharged from hospital 12 days after the operation. One year after surgery, there was no evidence of liver damage, injury or rejection.
The demand for liver transplants is increasing, and more people are dying from liver disease ,, but there are still a few organs available. There are currently over 11,000 people in the US waiting for a liver transplant, according to the Department of Health and Human Services, and waiting times vary hugely across the country. Clavien believes that this will revolutionize the way we treat liver diseases. “The proof is the patient–that he’s here, and knowing how he was before.”
I’m a journalist who specializes in investigative reporting and writing. I have written for the New York Times and other publications.