Paolo Rossi Castelli 30 June 2022 18 min read

Liver transplants are ok even with ‘rejected’ organs

A liver rejected by specialised centres has been ‘reconditioned’ using a special technique by a team from the University Hospital of Zurich and the Swiss Federal Institute of Technology and transplanted after 3 days. The patient who received it is doing well.

One year has passed since a Swiss patient awaiting a liver transplant received an organ that had been "rejected" by specialised Swiss centres in May 2021. The organ had been rejected because of critical conditions related to donor disease (the donor was a 29-year-old girl). It was ‘reconditioned’ through a special technique but remained outside the girl's body for three days and not, as usually happens, for only a few hours. As a rule the liver deteriorates after that time and is no longer transplantable).

The recipient had a rapidly advancing liver tumour and could not wait for a traditional transplant. This is why he volunteered for an experiment (the first of its kind) suggested by the Wyss Zurich Translational Centre, an institute created by a donation from entrepreneur Hansjörg Wyss, the University of Zurich and the Swiss Federal Institute of Technology, which embarked on the ambitious "Liver4Life"  project in 2015, focused on improving organ preservation techniques for transplantation to increase their availability.

Liver transplants: towards scheduled surgeries and less emergencies
The patient is doing well today, and his experience has been studied and recounted in a recently published article in the scientific journal Nature Biotechnology. Researchers hope that this first patient will be followed by many more, and that the tools developed may become part of the equipment in other transplant centres.  

In short, the multidisciplinary team created a machine that reproduces as faithfully as possible what happens in the human body. So the liver was connected to a pump that mimicked the heart, a mini-dialysis machine that performed kidney functions, and oxygenation equipment that replicated the lungs.

Researchers also inserted an artificial diaphragm, which ‘dammed up’ the liver just like a real diaphragm (the muscle that separates the chest cavity from the abdominal cavity), and the whole thing was subjected to gentle movement at the rate of normal human breathing.

Infections were eliminated
While under perfusion, the liver received essential elements like minerals, vitamins, hormones, growth factors, and enzymes that mimic intestinal and pancreatic functions, but (and this is one of the secrets of the technique's success) the organ was also treated with drugs to improve its condition, eliminate possible ongoing infections and reduce inflammation from trauma.

In addition, having many extra hours allowed surgeons and other experts to perform accurate analyses without the urgency of just a few dozen minutes, as is usually the case. And this turned a liver considered unacceptable by current international standards into a potentially usable organ.

New trials
The next step will be to organise a multicentre study (in a range of hospitals, in different countries) to test whether the tools used in different facilities perform equally well, and if procedures and materials can then be standardised.

According to surgeons in Zurich, it may be possible to keep an organ outside the body for ten days before transplant, and, with the right modifications, the technique could be applied to other organs as well. In this way transplants can be scheduled more and become less urgent.



Photo credits: https://bit.ly/3QTictV 
Surgeon Pierre-Alain Clavien, head of the Department of Visceral Surgery and Transplantation at the University Hospital of Zurich, with the patient who received the 'regenerated' liver

 

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Paolo Rossi Castelli

Journalist since 1983, Paolo has been dealing with scientific divulgation for years, especially in the fields of medicine and biology. He is the creator of Sportello Cancro, the site created by corriere.it on oncology in collaboration with the Umberto Veronesi Foundation. He collaborated with the pages of the Science of Corriere della Sera for several years. He is the founder and director of PRC-Comunicare la scienza.