A human liver that had been kept out of the body for three days, thanks to the use of a new special machine, was transplanted for the first time in the world to a patient, a cancer patient, who has remained healthy for a year, Swiss and French scientists have now announced. The same interdisciplinary team had shown for the first time in 2020 that thanks to this technology it is possible to keep the liver out of the body for several days, while now the first transplant of such a long-preserved liver took place.
This new technology can expand the number of liver organs available for transplantation, which will allow for better scheduling of surgeries and possibly save several lives. There is a growing gap between the demand for liver transplants and the supply of available organs. So far the clinical practice is to store the donor’s liver on ice for up to about 12 hours, which limits the number of implants that may be suitable for a recipient.
Researchers from the Liver4Life (Liver for Life) team, which began its work in 2015, led by Professor Pierre-Allen Clavien, director of the Department of Surgery and Transplantation at the University Hospital of Zurich, published the biotechnology in the journal Biotechnology. . They proved that it is possible to preserve a human liver for three days with the help of a machine that performs a new technique (“ex situ normothermic perfusion”), in which the organ, while outside the body, is supplied with a blood substitute in physical body temperature.
The machine imitates the human body to the best of its ability, in order to provide the liver to be transplanted with ideal conditions for its preservation. A pump acts as a substitute for the heart, an oxygen-producing device replaces the lungs, and a dialysis unit performs the functions of the kidneys. In addition, the addition of appropriate hormones and nutrients replaces the functions of the intestine and pancreas. Also, like the diaphragm in the human body, the machine moves the liver at the rate of human respiration.
The liver to be transplanted was also prepared on the machine with various drugs. This made it possible for the liver to transform into a suitable organ, even though it had not initially been approved for transplantation due to its poor quality. The presence of the organ in the machine allowed the administration of antibiotics, hormones and substances to improve its metabolism. In addition, staying out of the body for days allows doctors to perform various laboratory and histological examinations on the liver without time pressure.
The patient who underwent the experimental liver transplant suffered from a variety of severe liver damage, including advanced cirrhosis. The transplanted liver functioned normally, and only a basic immunosuppression was needed during the first six weeks after the transplant. The patient, who was released from the hospital in a few days, quickly regained his quality of life, with no more signs of liver damage, and remains healthy one year after surgery.
“I am very grateful for this life-saving organ. Due to my rapidly evolving tumor, I had little chance of finding a liver from the waiting list within a reasonable time,” the patient said.
The team said, however, that further research would be needed, with more patients and longer follow-up periods, before the new method could be widely applied. That is why a multicenter study will follow that will confirm the safety and effectiveness of the new technique.
If all goes well, in a few years the liver transplants, which today are usually done with the emergency procedure, will be transformed into pre-planned surgeries. At the same time, a new generation of machines for preserving organs for transplantation has already begun to develop.
Link to the scientific publication: https://www.nature.com/articles/s41587-022-01354-7
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