In January 2020, Zurich researchers, known as the Liver4Life team, announced that they had radically extended the length of time a donor’s liver could remain viable during storage – by keeping a number of “poor” livers alive for one week.
It was a big story that flew through the radar – probably because there was no real transplant at the time.
Rather, the study showed what was possible with the new perfusion device, which mimics many bodily functions and essentially keeps the liver functioning for several days.
This week, the Liver4Life team announced that they had successfully transplanted a patient with liver cancer that had been maintained viable at the device for three days.
The transplant itself took place about a year ago, and an unnamed male patient seems to be doing well.
Usually a maximum of twelve hours
In standard practice, donor livers are stored on ice in the refrigerator for a maximum of 12 hours – with preservatives that prevent inflammation, supply nutrients and keep sodium and potassium low in cells.
After 12 hours, the cells begin to leak and swell and the organ loses viability.
The idea of extending liver viability to a week is therefore impressive – although it is unlikely that a healthy liver suitable for transplantation will have to be stored for several days.
As the researchers noted: “There is a great need for functional donor livers. In Switzerland alone, two to three times more people are waiting for the liver than can actually be transplanted. ”
The real value of this extended life and viability lies in the fact that it gains time for poor quality livers – which are considered unsuitable for transplantation – to rehabilitate and adapt to the patient in need.
Make rejected liver acceptable for transplant
Like the liver used in the 2020 experiment, the liver used in the transplant last year was originally rejected as a transplant organ.
Instead of being fired, he was connected to a perfusion device that “mimics the human body as closely as possible to provide ideal conditions for the human liver.”
The pump serves as a replacement heart, the oxygenator replaces the lungs and the dialysis unit performs kidney functions.
In addition, “numerous infusions of hormones and nutrients perform the functions of the intestine and pancreas.”
This imitation involved the movement of the liver to the rhythm of human respiration, as occurs naturally in the diaphragm.
Over three days, the liver was treated with antibiotics, hormone therapies, and drugs that optimized liver metabolic function.
During this time, long laboratory and tissue tests were performed without time constraints.
“In this way,” the researchers wrote, “it was possible to turn the liver into a good human organ, even though it was not originally approved for transplantation due to its poor quality.”
Out of the lab into the body
The transplant patient was on the Swiss waiting list for organ donors and suffered from a “rapidly progressing tumor.”
He later said, “I had little chance of getting the liver off the waiting list in a reasonable amount of time.
The researchers explained that they had rehabilitated livers at their disposal. Was he willing to try it?
The man was admitted and the liver was transplanted in May 2021. The patient managed to leave the hospital a few days after the transplant and “is now doing well.”
The rehabilitated liver seems to have exceeded expectations.
As the authors note in their groundbreaking work: “The transplanted liver showed normal function with minimal reperfusion injury and the need for only a minimal immunosuppressive regimen.
“The patient quickly restored a normal quality of life without any signs of liver damage, such as rejection or biliary tract injury, according to annual follow-up.”
Of course, the process needs to be repeated for other patients. Liver4Life is already working to improve its perfusion machine.
If successful until the rehabilitation process is widely accepted, researchers believe that “in the future, liver transplantation, which is usually an emergency procedure, would become a planable option.”
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