Technical feasibility of liver transplantation without cold storage

Area of Science:

• Hepatobiliary Surgery
• Transplant Immunology
• Organ Preservation

Background:

• Increasing demand for liver allografts necessitates the use of marginal organs.
• Older donors and organs with steatosis pose challenges in liver transplantation.
• Novel techniques are needed to improve outcomes with extended criteria donors.

Purpose of the Study:

• To demonstrate the technical feasibility of in situ preparation and immediate warm-ischemia liver transplantation (WI-LT).
• To report the transplant course and outcomes of patients undergoing WI-LT.
• To evaluate the potential of WI-LT in improving allograft quality, particularly with marginal organs.

Main Methods:

• Six patients underwent WI-LT, with parallel hepatectomy and transplantation by separate surgical teams.
• Technical factors during procurement and transplantation were meticulously analyzed.
• Postoperative allograft function was assessed through biochemical markers and clinical outcomes.

Main Results:

• All six WI-LT procedures were completed without intraoperative complications.
• The mean warm-ischemia time (WIT) was 29.0 minutes.
• Excellent early allograft function was observed, with low postoperative liver enzyme levels, indicating minimal ischemia/reperfusion injury.

Conclusions:

• WI-LT is a safe and technically feasible approach for liver transplantation.
• This technique may reduce ischemia-reperfusion injury (IRI), leading to improved postoperative allograft quality.
• WI-LT could be a valuable option for selected patients, especially those receiving extended criteria donor livers.