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.
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This study was performed by the Consortium for Organ Preservation in Europe (COPE). We thank the European Commission for their support through the Seventh Framework Programme. The following organisations, groups and individuals also made substantial contributions without which this trial could not have been completed successfully: NHS Blood and Transplant; the Surgical Intervention Trials Unit, University of Oxford; the Clinical Trials and Research Governance unit, University of Oxford; Centre for Evidence in Transplantation, Royal College of Surgeons of England; the Liver Transplant Coordinators, anaesthetists and liver unit physicians at the Queen Elizabeth Hospital, Birmingham, Addenbrooke’s Hospital, Cambridge, King’s College Hospital, London, the Royal Free Hospital London, Hospital Clinic, Barcelona, University Hospitals, Leuven, University Hospital, Essen; M. Soo, S. Morrish, C. Morris, L. Randle, R. Macedo Arantes, R. Morovat, A. Elsharkawy, G. Hirschfield, P. Muiesan, J. Isaac, J. Grayer, B. Buchholz, H. Vilca-Melendez, A. Zamalloa, D. Chasiotis, S. Khorsandi, B. Davidson, D. Sharma, A. Esson, D. Monbaliu, S. Mertens, S. Swoboda, J. Neuhaus, T. Benkö, V. Molina, R. Kumar, A. Bradley, M. Laspeyres, B. Patel, A. Mukwamba, S. Banks, the COPE Transplant Technicians, the Specialist Nurses in Organ Donation and, of course, all of the donors and their families. This study was funded by a European Commission Seventh Framework Programme (FP7) Grant (No 305934).
Nature thanks S. Schneeberger, S. G. Tullius and the other anonymous reviewer(s) for their contribution to the peer review of this work.