Fresh hope for liver transplant patients thanks to ground-breaking research
Preserving livers at body temperature may improve transplant outcomes and increase the availability of viable donor livers, ground-breaking research carried out in collaboration with the University of Birmingham and University Hospitals Birmingham NHS Foundation Trust has revealed.
The University of Oxford-led research, which has the potential to save more lives and reduce liver transplant waiting lists, was published today in Nature.
Rising liver disease rates have rendered the supply of viable donor organs inadequate. Many potential donor livers are deemed too high risk and can be damaged during the time they are refrigerated. Refrigeration occurs to preserve organs mid-transplant.
However, now a trial called COPE (Consortium for Organ Preservation in Europe) has found that a promising alternative lies in maintaining donor livers at body temperature, supplying the organs with oxygenated blood, medications and nutrients — much like a patient on life support — through a process called normothermic machine perfusion.
Livers can be kept in this manner for 24 hours, and the process could one day enable the monitoring of organ viability, along with treatment and repair of organs as needed.
Measuring biomarkers of liver damage, the trial found a 50% reduction in graft injury in livers that had been perfused, compared to those kept in cold storage. In addition, in the year after transplant, the researchers found no significant differences in rates of bile duct complication, or graft and patient survival rates - as predicted by a clinically accepted biomarker - between preservation approaches.
Hynek Mergental, Honorary Senior Lecturer at the University of Birmingham and Consultant Surgeon at University Hospitals Birmingham NHS Foundation’s Liver Unit led the work in Birmingham which involved recruiting half of the 220 transplant patients who were involved in the COPE trial.
He said: “Making the most of available livers is a priority for those working in the area of transplantation.
“This innovative, randomised trial has confirmed the benefits of the novel, dynamic organ preservation technology.
“The trial has shown that livers transported in a perfusion machine were in a significantly better condition for transplant than those held on ice, making them more likely to produce good long-term results for the recipient.
“The other benefit of the machine perfusion was the possibility to keep the livers up to 24 hours outside the human body, extending the times by two to three folds compared to the ice-box storage.
“This would make the logistics of a transplant much easier, allowing surgical teams to be prepared and ready and ultimately make the whole process safer for the recipient patient. The longer preservation times and potential for greater organ numbers raise the real prospect of addressing the challenge of growing transplant waiting lists.”
University of Birmingham Honorary Professor Darius Mirza, Consultant Transplant Surgeon at University Hospitals Birmingham NHS Foundation Trust, also played a key role in the COPE study.
For more information please contact Emma McKinney, Communications Manager (Health Sciences), University of Birmingham, on +44 (0)121 414 6681. Alternatively, contact the Press Office out of hours on +44 (0)7789 921165.
Notes to editors
- The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 5,000 international students from over 150 countries.
- Nasralla et al (2018). ‘A randomized trial of normothermic preservation in liver transplantation’. Nature. DOI: 10.1038/s41586-018-0047-9
- University Hospitals Birmingham NHS Foundation Trust runs the Queen Elizabeth Hospital Birmingham, Birmingham Chest Clinic, Heartlands Hospital, Good Hope Hospital, Solihull Hospital and various community services across the region. The Trust has regional centres for trauma, burns, plastics, neurosciences, dermatology and cancer. It also has centres of excellence for vascular, bariatric and pathology services, as well as the treatment of MRSA and other infectious diseases. We also have expertise in HIV/AIDS, premature baby care, bone marrow transplants and thoracic surgery. UHB has the largest solid organ transplantation programme in Europe and runs Umbrella, the sexual health service for Birmingham and Solihull. It is also home to the West Midlands Adult Cystic Fibrosis Centre and a nationally-renowned weight management clinic and research centre. The Queen Elizabeth Hospital Birmingham is a Major Trauma Centre treating the most severely injured casualties from across the region. The hospital’s single site 100-bed critical care unit is the largest in Europe. The Trust hosts the Institute of Translational Medicine (ITM) and leads the West Midlands Genomics Medicine Centre as part of the national 100,000 Genomes Project. UHB is also proud to host the Royal Centre for Defence Medicine (RCDM) at the Queen Elizabeth Hospital Birmingham. The RCDM provides dedicated training for defence personnel and is a focus for medical research.