(ORDO NEWS) — When a donor organ becomes available to a person in need of a transplant, medical personnel must act quickly. It only takes a few hours for the expanding ice crystals to damage delicate tissue, leaving less than 12 hours to evaluate, transport and implant a new organ.
This not only creates a huge shortage of time for the delicate procedure, but also makes many organs unsuitable for transplantation.
However, a new breakthrough could significantly improve the situation with liver transplants: Scientists kept the liver unfrozen for three days before transplanting it into a patient.
Moreover, this liver was considered non-viable by the transplant centers because it had a tumor and was obtained from a patient with sepsis (a bacterial infection) who needed examination and treatment. A three-day window allowed the researchers to complete these steps, clearing the liver for transplant.
One year later, the recipient was completely healthy, with normal liver function and a normal quality of life. While further research is needed before widespread clinical use, these results may indicate an increase in the number of livers available for transplantation in the future.
“The success of liver transplantation over the past 30 years has led to a worldwide shortage of organs … the lack of available organs remains the most important factor limiting the success of transplantation,” writes a team of researchers led by surgeon Pierre-Alain Clavien from the University Hospital of Zurich and Wyss Zurich in Switzerland.
“This first clinical success breaks new ground in clinical research and promises to extend the time frame to 10 days for assessing the viability of donor organs, as well as making an urgent and highly complex operation an elective procedure.”
Note: Below is a graphic of the organ, so don’t scroll any further if you don’t want to see it.
The technique the team used to preserve the liver is gaining popularity in the medical world.
It is called normothermic perfusion ex situ (outside the body), and its principle is simple. The organ is placed in a sterile environment and maintained at 37 degrees Celsius, which is the normal temperature of the human body (“normothermal”).
In this environment, it is constantly flushed with fluids that mimic the functions of the human body, such as nutrients, hormones, and blood. In 2020, Wyss-Zurich demonstrated the effectiveness of its perfusion technology by keeping the human liver functioning normally for seven days out of the body.
On May 19, 2021, their research took a huge step forward. They were offered a liver transplant from a 29-year-old woman who suffered from invasive tumors and abdominal abscesses, as well as recurrent sepsis caused by antibiotic-resistant bacteria.
The liver itself contained a tumor of unknown nature, which would have required diagnostic testing before the organ was considered suitable for transplantation.
On the other hand, there was a recipient: a 62-year-old male suffering from advanced liver cirrhosis, severe portal hypertension, and multiple and recurrent liver cancer.
He was fully informed of the experimental nature of the procedure and accepted the risk, not least because his condition was so dire that the chances of a timely liver transplant through the usual transplant lists were virtually nil.
On May 22, 2021, at the beginning of the fourth day after the removal of the donor organ, the transplantation procedure took place. It was a complex procedure that required a team of engineers, biologists and doctors to work together.
And it was successful, with great success: There was absolutely no sign of the damage that can occur, the so-called reperfusion injury, when blood returns to the tissues after a period of complete lack of blood supply.
According to the researchers, the result was comparable to a living donation, when an organ transplant is removed from a living donor and transplanted directly into the recipient.
The only intervention required was a standard six-week immunosuppression regimen to avoid rejection of the donor organ by the recipient. The transplanted liver functioned normally and had no side effects – no signs of rejection, no damage to the bile ducts, which happens often.
A year later, he still felt good. In general, this is a remarkable and very promising result.
“Because liver transplantation remains one of the most complex and resource-intensive surgical procedures currently performed on an urgent basis outside the usual schedule, prolonged ex situ perfusion may allow such operations to be made an elective procedure, similar to living donation,” the researchers say.
“We believe that this first success of transplantation using an ex situ preserved organ with normothermic perfusion could open up new horizons in the treatment of many liver diseases.”
Contact us: [email protected]