In the Journals

Normothermic machine perfusion for liver storage improves graft, patient survival

Normothermic machine perfusion for donated livers had a 50% lower rate of graft injury and no significant difference in bile duct complications, graft survival or patient survival compared with conventional static cold storage, according to a recently published study.

“Despite many advances in liver transplantation, the method of organ preservation has changed very little in almost 30 years. In recent years, interest has developed in perfusion at physiological temperature,” David Nasralla, MRCS, from the University of Oxford, United Kingdom, and colleagues wrote. “During [normothermic machine perfusion (NMP)], the liver is perfused with oxygenated blood, medications and nutrients at normal body temperature to maintain a physiological milieu.”

Between June 2014 and March 2016, Nasralla and colleagues randomly assigned donation after brain death (DBD) livers and donation after cardiac death (DCD) livers to undergo either NMP or static cold storage (SCS).

During the first 7 days after liver transplantation, the researchers observed a 49.4% reduction in peak aspartate aminotransferase levels among patients who received livers that underwent NMP compared with SCS (P < .001). The reduction in geometric mean peak AST was higher in DCD livers compared with DBD livers (73.3% vs. 40.2%).

Surgery

Patients who received livers that underwent NMP had a significantly lower risk for early allograft dysfunction (74%; P < .001) after initial analysis and after adjusting for donor type, MELD score and ET-DRI (72%; P = .002).

After comparing the two storage procedures, the researchers observed no significant difference in biliary stricture occurrence between either DBD or DCD livers; no significant differences in median intensive care unit stay, hospital stay or need for renal replacement therapy; no significant difference in 1-year graft survival; and no significant difference in the rate of adverse events.

“High-risk organs (for example, those with steatosis) may benefit from therapeutic interventions delivered during NMP: several groups are exploring potential strategies, including stem cell treatments, de-fatting agents and immunological modification of the organ,” the researchers wrote. “Future trials may be needed to formally test the size of the effect of NMP on organ utilization; for this it will be necessary to randomize livers at the time of organ offering rather than the time of retrieval.” – by Talitha Bennett

Disclosure: Nasralla reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.

Normothermic machine perfusion for donated livers had a 50% lower rate of graft injury and no significant difference in bile duct complications, graft survival or patient survival compared with conventional static cold storage, according to a recently published study.

“Despite many advances in liver transplantation, the method of organ preservation has changed very little in almost 30 years. In recent years, interest has developed in perfusion at physiological temperature,” David Nasralla, MRCS, from the University of Oxford, United Kingdom, and colleagues wrote. “During [normothermic machine perfusion (NMP)], the liver is perfused with oxygenated blood, medications and nutrients at normal body temperature to maintain a physiological milieu.”

Between June 2014 and March 2016, Nasralla and colleagues randomly assigned donation after brain death (DBD) livers and donation after cardiac death (DCD) livers to undergo either NMP or static cold storage (SCS).

During the first 7 days after liver transplantation, the researchers observed a 49.4% reduction in peak aspartate aminotransferase levels among patients who received livers that underwent NMP compared with SCS (P < .001). The reduction in geometric mean peak AST was higher in DCD livers compared with DBD livers (73.3% vs. 40.2%).

Surgery

Patients who received livers that underwent NMP had a significantly lower risk for early allograft dysfunction (74%; P < .001) after initial analysis and after adjusting for donor type, MELD score and ET-DRI (72%; P = .002).

After comparing the two storage procedures, the researchers observed no significant difference in biliary stricture occurrence between either DBD or DCD livers; no significant differences in median intensive care unit stay, hospital stay or need for renal replacement therapy; no significant difference in 1-year graft survival; and no significant difference in the rate of adverse events.

“High-risk organs (for example, those with steatosis) may benefit from therapeutic interventions delivered during NMP: several groups are exploring potential strategies, including stem cell treatments, de-fatting agents and immunological modification of the organ,” the researchers wrote. “Future trials may be needed to formally test the size of the effect of NMP on organ utilization; for this it will be necessary to randomize livers at the time of organ offering rather than the time of retrieval.” – by Talitha Bennett

Disclosure: Nasralla reports no relevant financial disclosures. Please see the full study for the other authors’ relevant financial disclosures.