A randomized trial of normothermic preservation in liver transplantation.

Abstract

Liver transplantation is a highly successful treatment, but is severely rationed by the shortage of 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. In a randomised trial enrolling 270 livers, we have shown that, when compared with 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 or patient survival. If translated to clinical practice, these results would have a major impact on liver transplant outcomes and waiting list mortality.