Donor livers can now be preserved for a significantly longer duration in a specialized perfusor machine without compromising recipients' safety. This advancement allows for safe postponement of liver transplantation until the following morning. The UMCG reported this breakthrough in liver transplantations on January 9th.
Since the beginning of 2023, the UMCG has been performing hour-long liver transplantations routinely during daytime hours. This became possible due to the extended preservation capability of donor livers in a specialized perfusor machine at the UMCG, without compromising their quality. Research published in The Lancet from UMCG indicates that this extended preservation period is safe for recipients. The treatment outcomes following prolonged preservation were as successful as immediate transplantations performed when the donor liver became available.
The UMCG is the world's first hospital to apply cooled organ perfusion, allowing standard scheduling of liver transplantations during the day.
Treatment of Donor Livers in Perfusor Machine
Donor livers can only be preserved outside the body for a short period, typically 6 to 10 hours. Hence, the organ needs to be transplanted promptly to the recipient, leading to significant time pressure during transplantations. Since 2015, the UMCG has had an 'Organ Preservation & Resuscitation' unit where donor organs such as livers, lungs, and kidneys can be treated in perfusor machines with oxygenated fluid before transplantation. With these new perfusion techniques, organs can not only be better preserved but also improved and even tested just before transplantation. This increases the number of organs available for transplantation, valuable gifts provided by donors.
Safety of Prolonged Preservation in Perfusor Machine
UMCG has been studying since November 2020 whether it's safe to preserve donor livers for an extended period in a perfusor machine. Two methods of organ preservation and transplantation were compared. If the donor liver became available before 4:00 PM, preparations for surgery began immediately, and the operation followed. This often led to surgeries extending into the late hours since a liver transplantation averages 10 hours. If the donor liver became available after 4:00 PM, it was immediately connected to the cooled perfusor machine upon arrival at UMCG for preservation. The surgery then commenced the next morning, extending the preservation time up to 20 hours. This study aimed to verify the safety of consciously delaying a donor liver's transplantation. Both donors and recipients were similar in terms of age, gender, and other characteristics in both groups.
No Complications or Mortality for Recipients
The research showed no significant difference for recipients of donor livers. Prolonged preservation did not compromise the quality of donor livers and was equally safe for recipients. There were no complications related to the extended preservation period within 30 days post-operation. Additionally, at least a year after surgery, all patients were still alive with well-functioning livers.
Elimination of Nighttime Surgeries
The benefits of the new transplantation method are substantial. According to Vincent de Meijer, Professor of Surgery and head of the liver transplantation program at UMCG, liver transplantation has become more predictable. 'Surgeries no longer need to be performed immediately upon the availability of a donor organ. Operating in the middle of the night is no longer necessary. This leads to fewer teams required during night shifts. Furthermore, in case of complications or unexpected events during surgeries, we no longer need to call in additional colleagues because they are already present during the daytime. It also leads to more rested surgical teams, contributing significantly to the sustainable performance of everyone involved.'
UMCG World's First to Perform Liver Transplantations Routinely During Daytime: These findings have led to almost every liver transplantation in the UMCG being performed during daytime hours since January 1st, 2023. The UMCG is the first hospital globally to use organ perfusion for cooled preservation of donor livers, enabling routine daytime transplantation. De Meijer states, 'Out of the 83 liver transplantations we conducted this year at UMCG, 79 were performed during the day. This includes transplantations in children and re-transplantations where a patient receives a donor liver for the second or third time. Only in extremely rare, acute situations was an immediate transplantation performed.'
Shorter Duration of Liver Transplantations
After nearly a year, De Meijer explains two additional benefits. 'Firstly, this has lowered the threshold for combined heart-liver or lung-liver transplantation than before. Since the liver can now be preserved safely for longer, we can perform the heart or lung transplantation first without time pressure and then proceed to the liver transplantation. Secondly, the study found that surgeries where a liver was transplanted during the day lasted, on average, nearly two hours shorter than nighttime transplantations. This is likely due to daytime teams being slightly more alert.'
Source article: umcg.nl
Source Images: UMCG
