Prof. Pierre-Alain Clavien and Prof. Philipp Dutkowski during the transplantation of the liver treated in the machine.

Doctors successfully transplant liver that spent three days outside a body

Image credit: USZ

Surgeons have successfully transplanted a donor liver kept warm and alive outside the body for three days, using an innovative perfusion machine.

Cooled livers can usually only stay alive 12 hours after being removed from a human body. However, a team of Zurich scientists have been able to successfully transplant a liver that lived three days inside a machine.

The machine allowed scientists to stretch the viability of the organ for three days and it may even be able to expand it for as long as 10 days, the Swiss team told the journal Nature Biotechnology. The feat involved a collaboration between the University Hospital Zurich (UHZ), ETH Zurich and the University of Zurich.

“Our therapy shows that by treating livers in the perfusion machine, it is possible to alleviate the lack of functioning human organs and save lives,” said Professor Pierre-Alain Clavien from the UHZ.

The team was able to transform a liver that was originally considered too poor-quality to be transplanted into a quality organ. To do this, the scientists optimised liver metabolism through multi-day perfusion. Usually, these processes have to be performed under intense time pressure, as every second that the liver spends outside a human body (stored in ice or in current commercially available machines) significantly reduces its life. 

However, the perfusion machine is able to extend the organ's life outside a human body, by mimicking one as accurately as possible. In the machine, a pump serves as a heart, an oxygenator replaces the lungs and a dialysis unit performs the functions of a kidney. Moreover, using normothermic perfusion, the device can give the organ a continuous blood supply.

This is how a cancer patient on the Swiss transplant list (after providing consent) received a new liver, four days after the donor organ was removed from its original owner - a 29-year-old woman who died in May 2021.

The patient was able to leave the hospital after 12 days and he is still doing well a year later.

“I am very grateful for the life-saving organ,” he said. “Due to my rapidly progressing tumour, I had little chance of getting a liver from the waiting list within a reasonable period of time.”

With this new machine, the research team hopes to help reduce the number of donor organs that have to be discarded, since preserving tissues and organs at low temperatures can cause substantial cell damage. So far, the results look very promising, but doctors say that more research, with more patients and longer observation periods, is still needed.

“The interdisciplinary approach to solving complex biomedical challenges embodied in this project is the future of medicine,” said Professor Mark Tibbitt from ETH Zurich.

The next step in the Liver4Life project is to review the procedure on other patients and to demonstrate its efficacy and safety in the form of a multicenter study. If successful, the scientists will be able to transform an emergency procedure such as an organ transplant, into a plannable elective surgery. In addition, those involved in basic research continue to look for ways of treating other liver diseases outside the body with drugs, molecules or hormones.

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