Extended machine perfusion for the recovery of high-risk donor livers

Liver transplantation is the only curative treatment for end-stage liver disease but donor livers are scare. This project aims to establish a new, modular-build perfusion device which allows dynamic preservation of injured human livers for 1 week to recover and repair injured high-risk donor livers to allow subsequent transplantation.

The general shortage of donor organs together with increasing demands for liver transplantation has generated a global crisis in transplantation medicine, with a waiting list mortality approaching 20%. This shortage has led to the use of high-risk donor livers for transplantation. Ex situ machine perfusion for several hours is increasingly used to recondition such livers and to assess viability before transplantation. The organ shortage might be further remedied by long-term machine perfusion for up to 7 days by repairing injured, poor-quality livers which are now discarded.

To achieve this, a new perfusion device will be developed to support and maintain liver metabolism and homeostasis. This device will be based on the current perfusion machine (Liver Assist, Organ Assist Products B.V.). The new machine, however, has to mimic the human body by replacing the different organ systems, including an artificial kidney, pancreas, heart and lungs, continuous nutritional supplementation and a lipid filter, while continuous monitoring and protecting the liver and its environment.

It is expected to develop a functional machine perfusion device which will be ready for experimental use to repair injured human donor livers. When successful, the number of donor livers suitable for transplantation will be substantially increased, leading to a reduction of waiting list mortality for patients with end-stage liver disease.