For the first time in the Netherlands, a patient has received a donor liver that was optimized in a perfusion machine (Liver Assist) after having been rejected for transplantation. The patient is making an excellent recovery.
The transplant was part of an experiment in which donor livers considered unsuitable for transplantation are ‘refurbished’ in a perfusion machine. The donor liver was perfused on the Liver Assist with a special, cold oxygen-enriched liquid, before being gradually warmed up to a temperature of 37 degrees to bring it ‘back to life’. The donor liver regained its normal colour and acidity and started to produce bile. Once it had been thoroughly tested outside the body, the liver was successfully transplanted into the patient.
‘This is fantastic news because it will enable us to increase the supply by making more donor livers suitable for transplantation’, says Robert Porte, liver transplant surgeon in the UMCG. ‘Increasingly more potential donors have disorders, such as diabetes and obesity, which reduce the quality of their organs. In view of the huge shortage of donor organs, it is important that we can use these organs for transplantation.’
New perfusion liquid
Donor organs are usually stored on ice and transported to a transplant centre. Warming up a donor organ to 37 degrees stimulates the metabolism and encourages the liver to function as it would inside the body, making it possible to test the vitality and functioning. This cannot be done with a ‘cold’ donor organ because the metabolism is brought to a near-standstill. A special liquid developed in the UMCG enables a donor liver to be warmed up on the perfusion machine before being tested. Donor blood is no longer needed to perfuse the donor organ. In addition to nutrients, this liquid contains a special protein that can transport oxygen both at low temperatures and at body temperature. The UMCG is the first in the world to use this new perfusion liquid.
The UMCG has been running an ‘Organ Preservation & Resuscitation’ unit since 2015. In this unit, donor organs such as livers, lungs and kidneys are treated with an oxygen-enriched liquid and nutrients in perfusion machines to prepare them for transplantation. The new perfusion technique not only means that organs can be stored more efficiently, but also that they can be enhanced and tested immediately before they are transplanted. As a result, more organs can be made suitable for transplantation. In the past, the UMCG successfully transplanted rejected lungs after optimizing them in a perfusion machine.
In 2016, a total of 159 liver transplants were carried out in the Netherlands. Although more people would like to donate organs, a substantial number of them are automatically deemed unsuitable as donors. The UMCG expects that this new technique will enable some of the livers initially rejected to be made suitable for transplantation.