Transplantation of discarded livers following viability testing with normothermic machine perfusion

Research output: Contribution to journalArticlepeer-review


  • Hynek Mergental
  • M Thamara P R Perera
  • Yuri L Boteon
  • Joseph Attard
  • Darren Barton
  • Manpreet Wilkhu
  • Paolo Muiesan
  • John R Isaac
  • Keith J Roberts
  • Manuel Abradelo
  • Andrea Schlegel
  • James Ferguson
  • Hentie Cilliers
  • Julian Bion
  • David Adams
  • Chris Morris
  • Peter J Friend
  • Christina Yap
  • Simon Afford
  • Darius F Mirza

External organisations

  • University Hospitals Birmingham NHS Foundation Trust (UHBFT)
  • University of Oxford


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 ( 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
Issue number1
Publication statusPublished - 16 Jun 2020