Clinical Implementation of Prolonged Liver Preservation and Monitoring Through Normothermic Machine Perfusion in Liver Transplantation
Benno Cardini, Rupert Oberhuber, Margot Fodor, Theresa Hautz, Christian Margreiter, Thomas Resch, Stefan Scheidl, Manuel Maglione, Claudia Bösmüller, Harald Mair, Marion Frank, Florian Augustin, Andrea Griesmacher, Harald Schennach, Judith Martini, Robert Breitkopf, Stephan Eschertzhuber, Werner Pajk, Alois Obwegeser, Herbert Tilg, Christopher J.E. Watson, Dietmar Öfner, Annemarie Weißenbacher, Stefan Schneeberger
Abstract
BACKGROUND: Normothermic machine perfusion (NMP) bears the potential for significant prolongation of liver preservation before transplantation. Although safety and feasibility have been recently published, no data are available describing the significant challenges of establishing NMP programs outside clinical studies. We herein present our experience and propose a multidisciplinary approach for liver NMP in the clinical routine. METHODS: In February 2018, liver NMP was introduced for routine use in marginal organs, logistic challenges, and complex recipients at our institution. In a multidisciplinary effort among transplant coordinators, perfusionists, transplant surgeons, anesthesia, nurses, blood bank as well as laboratory staff, a clinical routine was established and 34 NMP cases were performed without critical incidents or organ loss. RESULTS: Nine livers were discarded due to poor organ quality and function observed during NMP. Twenty-five livers were successfully transplanted after preservation of up to 38 h. The extended criteria donors rate was 100% and 92% in discarded and transplanted livers, respectively. Nighttime procedures and parallel transplantations were eventually omitted. Graft and patient survival was 88% at 20 mo. No cholangiopathy was observed despite the use of extended criteria donor organs in 92% of cases. CONCLUSIONS: NMP in a multidisciplinary approach enables a safe prolongation of liver preservation and overnight organ care. A first field test of NMP indicates safety and benefit of this approach.