New hope for donor livers previously thought unsuitable for transplant

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A new clinical trial is looking at the feasibility of using ‘discarded’ livers to tackle the shortage of liver donors, and help decrease waiting times for patients on the transplant register.

Advances in technology mean that researchers may be able to identify whether some livers which would previously have been discarded, are in fact safe to transplant. This trial follows on from a successful pilot study which resulted in the transplantation of five livers that were initially rejected for use. All patients responded well to their transplant.

Livers may be deemed unsuitable for transplant due to the age of the donor, or damage due to disease or diet. During the period 2013 to 2015, *960 potential livers in the UK were rejected; 746 were not suitable for retrieval from donors and 214 were collected but could not be used.

In this trial researchers use a ground breaking machine called an OrganOx metra ™ to test the viability of an organ using strict criteria developed during pre-clinical research. A liver taken from a donor is placed on the OrganOx metra ™ so that oxygenated blood, medications and other fluids can be circulated through it at 37OC. If the liver demonstrates ‘metabolic function’, production of bile (i.e. normal daily functions) and stable perfusion flow rates, it will be transplanted into a suitable recipient who has given their consent.

Deaths from liver disease have soared by 40 per cent in a decade and continue to increase. Demand for liver transplants far exceeds availability of donors, so patients on the transplant waiting list are facing a longer wait and increased uncertainty whether a suitable liver can be found.

This trial is being led by researchers at the University of Birmingham and Queen Elizabeth Hospital Birmingham, in collaboration with OrganOx Ltd and the University of Oxford. Dr Richard Laing, Research Fellow from the University of Birmingham stated The method the OrganOx metrauses is called Normothermic Machine Perfusion of the liver (NMP-L). We believe that this study will demonstrate the potential of this novel technology to not only improve patient safety, but to increase the donor pool by transplanting livers which would have previously been declined.”

The trial, which is funded by the Wellcome Trust, starts early November 2016 and ends October 2017. It is being managed by Professor Darius Mirza and Mr Hynek Mergental, Consultant Transplant Surgeons at the Queen Elizabeth Hospital, and Dr Simon Afford, Reader in Liver Immunopathology at the University of Birmingham, with support from Clinical Research Fellows, Mr Richard Laing and Mr Yuri Boteon. The trial is supported by the NHSBT, the British Liver Trust, the British Transplantation Society and The Wellcome Trust.

*Source: Organ Donation & Transplantation Activity Report 2013/14 and 2014/15.

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