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Nature. 2018 May;557(7703):50-56. doi: 10.1038/s41586-018-0047-9. Epub 2018 Apr 18.

A randomized trial of normothermic preservation in liver transplantation.

Author information

1
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. david.nasralla@nds.ox.ac.uk.
2
Institute of Biomedical Engineering, Department of Engineering Science, University of Oxford, Oxford, UK. constantin.coussios@eng.ox.ac.uk.
3
Queen Elizabeth Hospital Birmingham, Birmingham, UK.
4
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
5
Target Discovery Institute, University of Oxford, Oxford, UK.
6
University of Cambridge Department of Surgery, Addenbrooke's Hospital, Cambridge, UK.
7
Centre for Statistics in Medicine, University of Oxford, Oxford, UK.
8
Surgical Intervention Trials Unit, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK.
9
Oxford Clinical Trials Research Unit, University of Oxford, Oxford, UK.
10
Department of Hepatobiliopancreatic and Transplant Surgery, Hospital Clinic, Barcelona, Spain.
11
Institute of Liver Studies, King's College Hospital, London, UK.
12
Department of Hepatopancreatobiliary and Liver Transplant Surgery, Royal Free Hospital, London, UK.
13
Abdominal Transplant Surgery, Department of Surgery, University Hospitals Leuven, Leuven, Belgium.
14
Laboratory of Abdominal Transplantation, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium.
15
Department of Radiology, King's College Hospital, London, UK.
16
Centre for Evidence in Transplantation, Clinical Effectiveness Unit, Royal College of Surgeons of England, London, UK.
17
Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
18
Department of Radiology, Queen Elizabeth Hospital Birmingham, Birmingham, UK.
19
OrganOx Limited, Oxford, UK.
20
Department of Radiology, Addenbrooke's Hospital, Cambridge, UK.
21
National Institute of Health Research (NIHR), Cambridge Biomedical Research Centre, Cambridge, UK.
22
Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK. peter.friend@nds.ox.ac.uk.

Abstract

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.

PMID:
29670285
DOI:
10.1038/s41586-018-0047-9
[Indexed for MEDLINE]

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