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 AdamsChris Morris, Peter J Friend, Christina Yap, Simon C Afford, Darius F Mirza

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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.

Original languageEnglish
Article number2939
JournalNature Communications
Volume11
Issue number1
DOIs
Publication statusPublished - 16 Jun 2020

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