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; Darius F Mirza

doi:10.1038/s41467-020-16251-3

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 language	English
Article number	2939
Journal	Nature Communications
Volume	11
Issue number	1
DOIs	https://doi.org/10.1038/s41467-020-16251-3
Publication status	Published - 16 Jun 2020

ASJC Scopus subject areas

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

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Mergental, H., Laing, R. W., Kirkham, A. J., Perera, M. T. P. R., Boteon, Y. L., Attard, J., Barton, D., Curbishley, S., Wilkhu, M., Neil, D. A. H., Hübscher, S. G., Muiesan, P., Isaac, J. R., Roberts, K. J., Abradelo, M., Schlegel, A., Ferguson, J., Cilliers, H., Bion, J., ... Mirza, D. F. (2020). Transplantation of discarded livers following viability testing with normothermic machine perfusion. Nature Communications, 11(1), Article 2939. https://doi.org/10.1038/s41467-020-16251-3

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title = "Transplantation of discarded livers following viability testing with normothermic machine perfusion",

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.",

author = "Hynek Mergental and Laing, {Richard W} and Kirkham, {Amanda J} and Perera, {M Thamara P R} and Boteon, {Yuri L} and Joseph Attard and Darren Barton and Stuart Curbishley and Manpreet Wilkhu and Neil, {Desley A H} and H{\"u}bscher, {Stefan G} and Paolo Muiesan and Isaac, {John R} and Roberts, {Keith J} and Manuel Abradelo and Andrea Schlegel and James Ferguson and Hentie Cilliers and Julian Bion and Adams, {David H} and Chris Morris and Friend, {Peter J} and Christina Yap and Afford, {Simon C} and Mirza, {Darius F}",

year = "2020",

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Mergental, H, Laing, RW, Kirkham, AJ, Perera, MTPR, Boteon, YL, Attard, J, Barton, D, Curbishley, S, Wilkhu, M, Neil, DAH, Hübscher, SG, Muiesan, P, Isaac, JR, Roberts, KJ, Abradelo, M, Schlegel, A, Ferguson, J, Cilliers, H, Bion, J , Adams, DH, Morris, C, Friend, PJ, Yap, C, Afford, SC & Mirza, DF 2020, 'Transplantation of discarded livers following viability testing with normothermic machine perfusion', Nature Communications, vol. 11, no. 1, 2939. https://doi.org/10.1038/s41467-020-16251-3

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T1 - Transplantation of discarded livers following viability testing with normothermic machine perfusion

AU - Mergental, Hynek

AU - Laing, Richard W

AU - Kirkham, Amanda J

AU - Perera, M Thamara P R

AU - Boteon, Yuri L

AU - Attard, Joseph

AU - Barton, Darren

AU - Curbishley, Stuart

AU - Wilkhu, Manpreet

AU - Neil, Desley A H

AU - Hübscher, Stefan G

AU - Muiesan, Paolo

AU - Isaac, John R

AU - Roberts, Keith J

AU - Abradelo, Manuel

AU - Schlegel, Andrea

AU - Ferguson, James

AU - Cilliers, Hentie

AU - Bion, Julian

AU - Adams, David H

AU - Morris, Chris

AU - Friend, Peter J

AU - Yap, Christina

AU - Afford, Simon C

AU - Mirza, Darius F

PY - 2020/6/16

Y1 - 2020/6/16

N2 - 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.

AB - 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.

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U2 - 10.1038/s41467-020-16251-3

DO - 10.1038/s41467-020-16251-3

M3 - Article

C2 - 32546694

SN - 2041-1723

VL - 11

JO - Nature Communications

JF - Nature Communications

IS - 1

M1 - 2939

ER -

Transplantation of discarded livers following viability testing with normothermic machine perfusion

Abstract

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