A randomized trial of normothermic preservation in liver transplantation

David Nasralla (), Constantin C. Coussios (), Hynek Mergental, M. Zeeshan Akhtar, Andrew J. Butler, Carlo D. L. Ceresa, Virginia Chiocchia, Susan J. Dutton, Juan Carlos García-Valdecasas, Nigel Heaton, Charles Imber, Wayel Jassem, Ina Jochmans, John Karani, Simon R. Knight, Peri Kocabayoglu, Massimo Malagò, Darius Mirza, Peter J. Morris, Arvind Pallan, Andreas Paul, Mihai Pavel, M. Thamara P. R. Perera, Jacques Pirenne, Reena Ravikumar, Leslie Russell, Sara Upponi, Chris J. E. Watson, Annemarie Weissenbacher, Rutger J. Ploeg and Peter J. Friend ()
Additional contact information
David Nasralla: University of Oxford
Constantin C. Coussios: University of Oxford
Hynek Mergental: Queen Elizabeth Hospital Birmingham
M. Zeeshan Akhtar: University of Oxford
Andrew J. Butler: Addenbrooke’s Hospital
Carlo D. L. Ceresa: University of Oxford
Virginia Chiocchia: University of Oxford
Susan J. Dutton: University of Oxford
Juan Carlos García-Valdecasas: Hospital Clinic
Nigel Heaton: King’s College Hospital
Charles Imber: Royal Free Hospital
Wayel Jassem: King’s College Hospital
Ina Jochmans: University Hospitals Leuven
John Karani: King’s College Hospital
Simon R. Knight: University of Oxford
Peri Kocabayoglu: Visceral and Transplantation Surgery, University Hospital Essen
Massimo Malagò: Royal Free Hospital
Darius Mirza: Queen Elizabeth Hospital Birmingham
Peter J. Morris: University of Oxford
Arvind Pallan: Queen Elizabeth Hospital Birmingham
Andreas Paul: Visceral and Transplantation Surgery, University Hospital Essen
Mihai Pavel: Hospital Clinic
M. Thamara P. R. Perera: Queen Elizabeth Hospital Birmingham
Jacques Pirenne: University Hospitals Leuven
Reena Ravikumar: University of Oxford
Leslie Russell: OrganOx Limited
Sara Upponi: Addenbrooke’s Hospital
Chris J. E. Watson: Addenbrooke’s Hospital
Annemarie Weissenbacher: University of Oxford
Rutger J. Ploeg: University of Oxford
Peter J. Friend: University of Oxford

Nature, 2018, vol. 557, issue 7703, 50-56

Abstract: Abstract Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing. Here we show that, in a randomized trial with 220 liver transplantations, compared to conventional static cold storage, normothermic preservation is associated with a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time. There was no significant difference in bile duct complications, graft survival or survival of the patient. If translated to clinical practice, these results would have a major impact on liver transplant outcomes and waiting list mortality.

Date: 2018
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DOI: 10.1038/s41586-018-0047-9

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