Donor livers preserved and improved with room-temperature perfusion system

May 6, 2014, Massachusetts General Hospital

A system developed by investigators at the Massachusetts General Hospital (MGH) Center for Engineering in Medicine (CEM) and the MGH Transplant Center has the potential to increase both the supply and the quality of donor organs for liver transplantation. In their report, which has been published online in the American Journal of Transplantation, the research team describes how use of a machine perfusion system delivering a supply of nutrients and oxygen though an organ's circulation at room temperature preserved and improved the metabolic function of donor livers in a laboratory study. The system has not yet been tested clinically.

"By the time a donated organ is transplanted, it has sustained significant injury through lack of a blood supply," says Bote Bruinsma, MSc, of the MGH-CEM and Department of Surgery, lead author of the report. "By supporting , we can give the liver time to recover, preconditioning it before transplantation. The hope is that, in the near future, livers that currently are considered unsuitable for transplantation will be recovered by more advanced preservation techniques, significantly increasing the number of organs available for transplantation."

The continuing shortage of donor organs has already led to the limited use of organs from donors who do not meet the strict criteria for brain death but in whom death from cardiovascular failure is imminent and organs can be procured soon after death. The quality of organs from such donors is often less than that of organs procured after brain death because of the greater time elapsed between when circulation ceases and when the surgically removed organ is cooled for transportation. The authors note that increased use of such "marginal" organs requires improved methods of preservation beyond simple cold storage, which only slows the process of deterioration.

Several studies have shown that perfusing donor livers with a cold solution can reduce tissue damage, and small clinical trials found evidence that cold-perfusing livers prior to transplantation improved the donor organs' function. But while cold perfusion delays the restoration of the organ's metabolic activity until it is implanted, use of a warm perfusion solution could initiate several aspects of organ recovery before implantation, potentially allowing better assessment of the organ's viability than is currently possible. Studies of systems perfusing donor livers at body temperature have supported this possibility, but the author notes that rapidly warming and reoxygenating a cold-stored organ – either by perfusion at body temperature or by direct implantation into a recipient – causes further damage to an organ already compromised by the interrupted . This damage is an even greater concern when marginal organs are used.

The system evaluated in the current study perfuses the organ with a room-temperature (around 70˚ F) solution. Through the New England Organ Bank the investigators acquired seven – only two donated after – that had been judged unsuitable for transplant for a number of reasons. The organs were connected to the perfusion system via the hepatic artery and portal vein and perfused with a room-temperature solution containing oxygen, vitamins and other nutrients, and antioxidants for three hours following several hours of cold storage. Analysis of the fluid coming out of the livers during perfusion revealed that the organs were metabolically active – producing bile, albumin and urea – and markers of tissue damage were limited. Levels of the cellular energy molecule ATP in liver tissue actually increased during perfusion, implying that the process could help recover, not just preserve, the organ's function, potentially allowing the safe use of organs currently being discarded.

Bruinsma adds that measuring these and other metabolic signals during perfusion could significantly improve the ability to assess the quality of a donated liver, which is currently done based on limited parameters. "Demonstrating the feasibility of this approach in human livers is an enormous step forward in bringing this technology to clinical application," he explains. "We expect that systems will revolutionize the way the liver is preserved outside the body, significantly increasing the number of livers available for transplants and saving the lives of potentially thousands of patients." Bruinsma is an MD/PhD candidate at the University of Amsterdam and visiting graduate student in the MGH Department of Surgery

Korkut Uygun, PhD, of the MGH Center for Engineering in Medicine, a co-corresponding author of the report, adds, "We like how simple and straightforward this protocol is. It doesn't involve all the bells and whistles of temperature control or use of blood or similar oxygen carriers, and yet the liver clearly still continues to work and heal itself in this environment, which makes us very optimistic about rapid clinical translation and adoption." Uygun is an assistant professor of Surgery at Harvard Medical School.

Explore further: Studies offer insight on how to improve kidney and liver transplantation

Related Stories

Studies offer insight on how to improve kidney and liver transplantation

April 28, 2014
The quality of kidney and liver donations is fundamentally important for the longevity of transplants and the health of recipients. That's why it's critical to know which organs are suitable for transplantation, as well as ...

Could deceased heart attack victims expand donor pool?

November 11, 2013
Researchers from the U.K. suggest that using organs from donors after circulatory death (DCD) who also suffered a previous cardiac arrest out of the hospital environment could expand the pool of available livers for transplant. ...

Transplant expert dispels organ donation misconceptions

April 21, 2014
(HealthDay)—Misconceptions prevent many people from agreeing to donate their organs and potentially save a life, according to a transplant expert.

U.S. liver transplants declining

May 22, 2012
(HealthDay) -- The number of liver transplants in the United States has decreased since 2006, a new study finds.

Decline in available liver transplants expected

January 10, 2013
A new study, funded in part by the National Institutes of Health (NIH) and Health Resources and Services Administration, and published in the January 2013 issue of Liver Transplantation, a journal of the American Association ...

Antioxidant improves donated liver survival rate to more than 90 percent

February 25, 2013
Researchers from Italy have found that the antioxidant, N-acetylcysteine (NAC), when injected prior to harvesting of the liver, significantly improves graft survival following transplantation. Results published in the February ...

Recommended for you

Drug may help surgical patients stop opioids sooner

December 13, 2017
(HealthDay)—Opioid painkillers after surgery can be the first step toward addiction for some patients. But a common drug might cut the amount of narcotics that patients need, a new study finds.

Children best placed to explain facts of surgery to patients, say experts

December 13, 2017
Getting children to design patient information leaflets may improve patient understanding before they have surgery, finds an article in the Christmas issue of The BMJ.

Burn victim saved by skin grafts from identical twin (Update)

November 23, 2017
A man doomed to die after suffering burns across 95 percent of his body was saved by skin transplants from his identical twin in a world-first operation, French doctors said Thursday.

Is a common shoulder surgery useless?

November 21, 2017
(HealthDay)—New research casts doubt on the true effectiveness of a common type of surgery used to ease shoulder pain.

Study shows electric bandages can fight biofilm infection, antimicrobial resistance

November 6, 2017
Researchers at The Ohio State University Wexner Medical Center have shown - for the first time - that special bandages using weak electric fields to disrupt bacterial biofilm infection can prevent infections, combat antibiotic ...

Obesity increases incidence, severity, costs of knee dislocations

November 3, 2017
A new study of more than 19,000 knee dislocation cases in the U.S. between 2000 and 2012 provides a painful indication of how the nation's obesity epidemic is changing the risk, severity and cost of a traumatic injury.

0 comments

Please sign in to add a comment. Registration is free, and takes less than a minute. Read more

Click here to reset your password.
Sign in to get notified via email when new comments are made.