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Updated: Jun 7, 2025
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Ex Situ Normothermic Machine Perfusion of Donor Livers
Published on: May 26, 2015
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Evolution of morphological changes in donor livers undergoing normothermic machine perfusion
A L Paterson1, R Gaurav2, L Swift2
1Department of Histopathology, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK.
Histopathology
|November 20, 2024
Summary
Histological examination of livers undergoing normothermic machine perfusion (NMP) reveals key changes. Donor steatosis and cellular stress impact organ utilization, while varying degrees of necrosis affect transplant outcomes.
Area of Science:
- Hepatology
- Transplant Surgery
- Histopathology
Background:
- Liver transplantation faces organ shortages in the UK, with many retrieved livers not being transplanted.
- Normothermic machine perfusion (NMP) offers functional assessment of marginal donor livers using biochemical markers.
- Understanding histological changes during NMP is crucial for optimizing organ utilization.
Purpose of the Study:
- To describe the histological alterations occurring in donor livers during normothermic machine perfusion (NMP).
- To correlate histological findings with organ utilization and transplant outcomes.
- To identify specific histological features indicative of liver viability and potential dysfunction.
Main Methods:
- Retrospective review of 170 liver biopsies from 50 livers undergoing NMP.
- Biopsies were collected pre-NMP, at 4 hours of NMP, end-NMP, and implantation.
- Histological analysis focused on steatosis, cellular stress, necrosis, inflammation, and sinusoidal changes.
Main Results:
- Pre-NMP steatosis (38% large droplet, 32% small droplet) was associated with reduced organ utilization and cellular stress.
- Hepatocellular necrosis at end-NMP correlated with lower transplant rates.
- Sinusoidal dilation was common, particularly in donation after circulatory death donors, often improving post-perfusion.
Conclusions:
- Histological changes in NMP livers are primarily driven by donor-derived steatosis and stress.
- Retrieval and perfusion processes contribute to sinusoidal dilation and ischemic injury.
- Histological assessment during NMP can provide insights into organ viability and predict transplant success.
