First year experience of liver graft normothermic machine perfusion at University hospital Münster

Introduction Normothermic machine perfusion (NMP) of allografts is the most exciting next evolutionary step in solid organ transplantation. Using NMP harmful cold storage times can be reduced, hazardous reperfusion injury will be diverted from the recipient onto the machine and logistics of solid organ transplantation will shift from an emergency setting into a plannable procedure. Additionally, functionality testing prior transplantation will render liver transplant to a safer intervention avoiding early graft dysfunction as well as primary non-function (PNF).

Methods 22 postmortal donor liver allografts with a median donor age of 59.3 years, median donor BMI of 27.4 kg/m² and median DRI of 1.7 were connected onto NMP in Münster University Hospital since October 2019. Average cold ischeamia times was 6.5 hours before graft perfusion on the OrganOx metra device. Median NMP time was 12 hours. Perfusion with physiological pressure and flow rates wasconducted via portal vein and hepatic artery with three packages of packed red blood cells and 500 ml Gelatine-Polysuccinat (Gelafundin® 4 %). Selecting criteria for NMP was estimated time of arrival of the graft, quality concerns of grafts being suitable for perfusion or recipient issues such re-transplantation.

Results Since implementation of NMP in Münster University Hospital in October 2019 22 of 47 (47 %) accepted donor livers were perfused normothermically. Except of one liver allograft all NMP livers showed sufficient lactate clearance (lactate levels  <  3 mmol/l at 1-3 hours of NMP perfusion). In most patients transaminases peaked during NMP and there was no severe reperfusion syndome in recipients. Primary graft function was 95.5 %, one organ revealing insufficient lactate clearance on NMP went into PNF.

Conclusions Viability testing of poor quality, extended criteria donor livers using NMP has the potential for increasing the number of transplantable donor organs and thus faces the problem of organ shortage without jeopardizing recipient safety. Additionally, NMP can turn liver transplantation into a plannable, non-emergency procedure, allowing better teaching and training conditions.

Publication History

Article published online:
04 January 2021