Medical personnel need to act quickly when a donor organ becomes available. It only takes a few hours for ice crystals to damage delicate tissue, leaving a window of less than 12 hours to assess, transport, and implant the new organ.
This creates a huge time crunch to perform a delicate procedure, and leaves many organs unviable for transplantation.
A new breakthrough could vastly improve the landscape of liver transplantation, as scientists kept a liver for three days in non-frozen conditions before transplant.
Since it had a tumor and came from a patient with a disease that needed to be assessed and treated, it was deemed unviable by transplant centers. The researchers were able to perform these actions during the three-day window.
The recipient was healthy a year later and had a normal quality of life. The results could mean an increase in the number of viable organs for transplantation in the future.
The lack of available organs remains the most important factor limiting the success of transplantation, according to a team of researchers led by surgeon Pierre-Alain Clavi.
This inaugural clinical success opens new horizons in clinical research and promises an extended time window of up to 10 days for assessment of viability of donor organs as well as converting an urgent and highly demanding surgery into an elective procedure.
Don't scroll further if you don't want to see the graphic image of the organ.
The team used a technique that is gaining traction in the medical world.
The principle of ex situ normothermic perfusion is simple. An organ is placed in a sterile environment and maintained at a temperature around normal human body temperature.
It is constantly flushed with fluids mimicking human body functions. In 2020, Wyss Zurich demonstrated the efficacy of their technology by keeping a human liver functioning normally for seven days outside of the body.
The donor is in the bath. Clavien et al. are from Nature Biotechnology.
Their research took a huge step forward on 19 May 2021. They were offered a transplant from a 29-year-old woman who was suffering from abdominal tumors and sepsis.
It would have taken a diagnostic work-up before the organ could be considered suitable for transplantation because of the unknown nature of the tumor.
On the other side, there was a 62-year-old man suffering from advanced cirrhosis, severe portal hypertension, and multiple and recurrent liver cancer.
He was fully aware of the risks of the procedure and agreed to them because he had a very low chance of getting a transplant in time.
The transplant procedure took place on the beginning of the fourth day after the donor organ was recovered. The procedure required a team of people to work together.
It was a success, a resounding one, and there was absolutely no sign of the damage that can occur, known as reperfusion injury, when blood returns to tissue after a period of no blood supply at all.
The researchers said that the result was comparable to living donation, when an organ transplant is made from a willing living donor.
The only intervention required was the basic, standard regime of immunosuppression for six weeks. There were no signs of rejection or injury to the bile ducts, which is common after a transplant.
He was doing well a year later. It is a wonderful and promising result.
As liver transplantation remains one of the most challenging and resource intensive surgical procedures currently performed as an urgent procedure out of regular schedule, long-term ex situ perfusion could enable such surgeries to become an elective procedure, like living donation.
We think that this first transplantation success with an ex situ normothermic perfusion preserved organ can open new possibilities in the treatment of many liver disorders.
The research has been published.