Transplantation of discarded livers following viability testing with normothermic machine perfusion

Hynek Mergental (), Richard W. Laing, Amanda J. Kirkham, M. Thamara P. R. Perera, Yuri L. Boteon, Joseph Attard, Darren Barton, Stuart Curbishley, Manpreet Wilkhu, Desley A. H. Neil, Stefan G. Hübscher, Paolo Muiesan, John R. Isaac, Keith J. Roberts, Manuel Abradelo, Andrea Schlegel, James Ferguson, Hentie Cilliers, Julian Bion, David H. Adams, Chris Morris, Peter J. Friend, Christina Yap, Simon C. Afford () and Darius F. Mirza ()
Additional contact information
Hynek Mergental: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Richard W. Laing: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Amanda J. Kirkham: University of Birmingham
M. Thamara P. R. Perera: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Yuri L. Boteon: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Joseph Attard: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Darren Barton: University of Birmingham
Stuart Curbishley: University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
Manpreet Wilkhu: University of Birmingham
Desley A. H. Neil: University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
Stefan G. Hübscher: University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
Paolo Muiesan: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
John R. Isaac: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Keith J. Roberts: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Manuel Abradelo: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Andrea Schlegel: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
James Ferguson: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Hentie Cilliers: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Julian Bion: University of Birmingham
David H. Adams: University Hospitals Birmingham NHS Foundation Trust (UHBFT)
Chris Morris: OrganOx Limited
Peter J. Friend: OrganOx Limited
Christina Yap: University of Birmingham
Simon C. Afford: University of Birmingham and University Hospitals Birmingham NHS Foundation Trust
Darius F. Mirza: University Hospitals Birmingham NHS Foundation Trust (UHBFT)

Nature Communications, 2020, vol. 11, issue 1, 1-12

Abstract: Abstract There is a limited access to liver transplantation, however, many organs are discarded based on subjective assessment only. Here we report the VITTAL clinical trial (ClinicalTrials.gov number NCT02740608) outcomes, using normothermic machine perfusion (NMP) to objectively assess livers discarded by all UK centres meeting specific high-risk criteria. Thirty-one livers were enroled and assessed by viability criteria based on the lactate clearance to levels ≤2.5 mmol/L within 4 h. The viability was achieved by 22 (71%) organs, that were transplanted after a median preservation time of 18 h, with 100% 90-day survival. During the median follow up of 542 days, 4 (18%) patients developed biliary strictures requiring re-transplantation. This trial demonstrates that viability testing with NMP is feasible and in this study enabled successful transplantation of 71% of discarded livers, with 100% 90-day patient and graft survival; it does not seem to prevent non-anastomotic biliary strictures in livers donated after circulatory death with prolonged warm ischaemia.

Date: 2020
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DOI: 10.1038/s41467-020-16251-3

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