Transplantation of discarded livers following viability testing with normothermic machine perfusion

TLDR

Limited access to liver transplantation leads to many organs being discarded based on subjective assessment. The VITTAL trial aimed to evaluate normothermic machine perfusion (NMP) as an objective method for assessing high‑risk discarded livers across UK centres. Thirty‑one livers were perfused and deemed viable if lactate cleared to ≤2.5 mmol/L within 4 h, after which they were transplanted. The study found that 71 % of the livers met viability criteria, were transplanted with a median 18‑hour preservation, achieved 100 % 90‑day survival, yet 18 % of recipients developed biliary strictures requiring re‑transplantation over a median 542‑day follow‑up.

Abstract

Abstract There is a limited access to liver transplantation, however, many organs are discarded based on subjective assessment only. Here we report the VITTAL clinical trial (ClinicalTrials.gov number NCT02740608) outcomes, using normothermic machine perfusion (NMP) to objectively assess livers discarded by all UK centres meeting specific high-risk criteria. Thirty-one livers were enroled and assessed by viability criteria based on the lactate clearance to levels ≤2.5 mmol/L within 4 h. The viability was achieved by 22 (71%) organs, that were transplanted after a median preservation time of 18 h, with 100% 90-day survival. During the median follow up of 542 days, 4 (18%) patients developed biliary strictures requiring re-transplantation. This trial demonstrates that viability testing with NMP is feasible and in this study enabled successful transplantation of 71% of discarded livers, with 100% 90-day patient and graft survival; it does not seem to prevent non-anastomotic biliary strictures in livers donated after circulatory death with prolonged warm ischaemia.