Perfusion technique could boost number of viable donor livers

Author: Caroline White
Perfusion technique could boost number of viable donor livers
A technique that slows the rate of tissue deterioration and lengthens storage time, could boost the number of viable livers which can be safely used for transplantation, says the National Institute for Health and Care Excellence (NICE) in final guidance, published today.

A perfusion machine not only reduces the rate of tissue deterioration that occurs after the donor liver has been removed, but variations of the technique can also allow the liver to be flushed with blood at body temperature and supplied with oxygen, medicines, and nutrients, permitting its viability and function to be assessed.

The hope is that machine perfusion might save more lives and cut waiting times for liver transplantation.

End-stage liver disease kills 11,000 people every year in England. Deaths from liver disease have soared by 25 per cent in a decade and continue to rise, while the average age of death from liver disease- currently 50-59- continues to fall.

NICE recommends that the procedure is used under special arrangements while more data are gathered on its effectiveness.

Surgeons undertaking the procedure must inform patients of the pros and cons, comply with the relevant regulatory and legal requirements of the Human Tissue Authority, and enter details about all patients having this procedure into the NHS Blood and Transplant (NHSBT) UK transplant registry.

Professor Kevin Harris, programme director and clinical advisor for the Interventional Procedures Programme at NICE, said: “This procedure offers hope for patients needing a liver transplant. It offers another way of preserving the liver and assessing whether livers which might have previously been considered unsuitable, can be used safely.

“The latest evidence reviewed by a NICE committee concluded that the procedure worked well and was safe to be offered to patients who had been fully informed of the risks and benefits. Clinicians should seek approval from their trust’s management and record all data from the procedure in a database.”

He added: “By using this procedure, more patients on the organ transplant waiting list could be offered a chance of a transplant and there-by potentially extending their lives.”

Darius Mirza, professor of hepatobiliary and transplant surgery at University Hospitals Birmingham NHS Foundation Trust, said: "In the 30 years I've been involved with transplantation there have been three or four events which have been game changers and I'm absolutely certain we are looking at a game changer that will change the way we practice organ storage and transplantation.

"It is already changing practice at the centres that have been able to use this technology either within clinical trials or within an expansion of service evaluation."

John Forsythe, associate medical director at NHSBT, said: “There has been a huge amount of research in the area of preservation and perfusion methods that allow us to both assess precious donor organs and to enhance their function. This could potentially mean the organ works better and improve transplant outcomes.”

Vanessa Hebditch, director of policy at the British Liver Trust commented: “This new device offers real hope as it may improve transplant outcomes and allow livers that were previously thought to be unsuitable to be used and also increase the time that livers are able to be kept.

“It has the potential to shorten waiting list times and reduce mortality rates from advanced liver disease. After transplant, the vast majority of people go on to lead full and healthy lives and it is truly amazing to see the transformation.”

NHSBT figures show that in 2017-18, 1043 liver transplants were carried out in the UK and 359 patients were on the UK active transplant list.