A randomized trial of normothermic preservation in liver transplantation.
Nasralla D., Coussios CC., Mergental H., Akhtar MZ., Butler AJ., Ceresa CDL., Chiocchia V., Dutton SJ., García-Valdecasas JC., Heaton N., Imber C., Jassem W., Jochmans I., Karani J., Knight SR., Kocabayoglu P., Malagò M., Mirza D., Morris PJ., Pallan A., Paul A., Pavel M., Perera MTPR., Pirenne J., Ravikumar R., Russell L., Upponi S., Watson CJE., Weissenbacher A., Ploeg RJ., Friend PJ.
Liver transplantation is a highly successful treatment, but is severely limited by the shortage in donor organs. However, many potential donor organs cannot be used; this is because sub-optimal livers do not tolerate conventional cold storage and there is no reliable way to assess organ viability preoperatively. Normothermic machine perfusion maintains the liver in a physiological state, avoids cooling and allows recovery and functional testing. Here we show that, in a randomized trial with 220 liver transplantations, compared to conventional static cold storage, normothermic preservation is associated with a 50% lower level of graft injury, measured by hepatocellular enzyme release, despite a 50% lower rate of organ discard and a 54% longer mean preservation time. There was no significant difference in bile duct complications, graft survival or survival of the patient. If translated to clinical practice, these results would have a major impact on liver transplant outcomes and waiting list mortality.