Transplantation of discarded livers following viability testing with normothermic machine perfusion

Author:

Mergental HynekORCID,Laing Richard W.,Kirkham Amanda J.,Perera M. Thamara P. R.,Boteon Yuri L.ORCID,Attard Joseph,Barton DarrenORCID,Curbishley Stuart,Wilkhu Manpreet,Neil Desley A. H.ORCID,Hübscher Stefan G.,Muiesan Paolo,Isaac John R.,Roberts Keith J.,Abradelo Manuel,Schlegel Andrea,Ferguson James,Cilliers Hentie,Bion Julian,Adams David H.,Morris ChrisORCID,Friend Peter J.,Yap ChristinaORCID,Afford Simon C.,Mirza Darius F.ORCID

Abstract

AbstractThere 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.

Funder

Wellcome Trust

Publisher

Springer Science and Business Media LLC

Subject

General Physics and Astronomy,General Biochemistry, Genetics and Molecular Biology,General Chemistry

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