title: Transplantation of Declined Liver Allografts Following Normothermic Ex-Situ Evaluation.
abstract: The demand for liver transplantation (LT) exceeds supply, with rising waiting list mortality. Utilization of high-risk organs is low and a substantial number of procured livers are discarded. We report the first series of five transplants with rejected livers following viability assessment by normothermic machine perfusion of the liver (NMP-L). The evaluation protocol consisted of perfusate lactate, bile production, vascular flows, and liver appearance. All livers were exposed to a variable period of static cold storage prior to commencing NMP-L. Four organs were recovered from donors after circulatory death and rejected due to prolonged donor warm ischemic times; one liver from a brain-death donor was declined for high liver function tests (LFTs). The median (range) total graft preservation time was 798 (range 724-951) min. The transplant procedure was uneventful in every recipient, with immediate function in all grafts. The median in-hospital stay was 10 (range 6-14) days. At present, all recipients are well, with normalized LFTs at median follow-up of 7 (range 6-19) months. Viability assessment of high-risk grafts using NMP-L provides specific information on liver function and can permit their transplantation while minimizing the recipient risk of primary graft nonfunction. This novel approach may increase organ availability for LT.
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.|National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: H
authors.identifier: 0000-0001-5480-9380
authors.initials: H
authors.lastname: Mergental
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: M T P R
authors.identifier: 0000-0002-5417-3850
authors.initials: MT
authors.lastname: Perera
authors.affiliation: National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: R W
authors.identifier: 0000-0002-8143-4278
authors.initials: RW
authors.lastname: Laing
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: P
authors.initials: P
authors.lastname: Muiesan
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: J R
authors.initials: JR
authors.lastname: Isaac
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.affiliation: National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: B T F
authors.initials: BT
authors.lastname: Stephenson
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: H
authors.initials: H
authors.lastname: Cilliers
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: D A H
authors.initials: DA
authors.lastname: Neil
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK.
authors.forename: S G
authors.initials: SG
authors.lastname: Hübscher
authors.affiliation: National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK.
authors.forename: S C
authors.initials: SC
authors.lastname: Afford
authors.affiliation: Liver Unit, Queen Elizabeth Hospital Birmingham, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK. darius.mirza@uhb.nhs.uk.|National Institute for Health Research (NIHR) Birmingham Liver Biomedical Research Unit and Centre for Liver Research, Institute of Immunology and Immunotherapy, Institute for Biomedical Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. darius.mirza@uhb.nhs.uk.
authors.forename: D F
authors.initials: DF
authors.lastname: Mirza
mesh_terms: D000328:Adult; D000368:Aged; D064591:Allografts; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection / Q000517:prevention & control; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000378:metabolism*; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009926:Organ Preservation; D017063:Outcome Assessment, Health Care; D010477:Perfusion / Q000379:methods*; D010865:Pilot Projects; D055031:Primary Graft Dysfunction / Q000517:prevention & control; D014019:Tissue Donors / Q000600:supply & distribution*; D014022:Tissue Survival; D009927:Tissue and Organ Procurement / Q000379:methods*; D052096:Warm Ischemia
keywords: clinical research/practice; donors and donation: donor evaluation; donors and donation: extended criteria; liver allograft function/dysfunction; liver transplantation/hepatology; organ acceptance; organ perfusion and preservation; organ procurement and allocation