Rescue of a Discarded Liver Graft Through Viability Assessment Using Normothermic Ex Vivo Machine Perfusion

Area of Science:

• Hepatology
• Transplantation Surgery
• Organ Preservation

Background:

• Organ shortage significantly limits liver transplantation globally.
• Marginal donor livers, especially those with severe steatosis, are often discarded due to high primary graft dysfunction risk.
• Normothermic machine perfusion (NMP) offers a method for functional assessment and donor pool expansion.

Purpose of the Study:

• To present a case demonstrating the utility of NMP in utilizing a severely steatotic donor liver.
• To showcase a sequential dynamic preservation strategy involving dual hypothermic oxygenated perfusion (D-HOPE) and NMP.
• To evaluate the viability and safety of a marginal liver graft after NMP for transplantation.

Main Methods:

• A 60-year-old donor liver with 70% macrovesicular steatosis and 11-hour cold ischemia time was preserved using D-HOPE followed by NMP on the Liver Assist® platform.
• Graft viability was assessed during NMP by monitoring lactate clearance, bile production, and perfusate/bile pH.
• The assessed graft was transplanted into a 58-year-old recipient with metabolic dysfunction-associated liver disease and hepatocellular carcinoma.

Main Results:

• NMP for 2 hours confirmed graft viability, evidenced by lactate clearance (0.5 mmol/L), bile production (16 mL), and favorable pH.
• The transplant recipient experienced a favorable postoperative course with no graft-related complications.
• One-year follow-up confirmed preserved graft and patient survival.

Conclusions:

• Normothermic machine perfusion, as part of a dynamic preservation strategy, can enable the safe use of initially unsuitable liver grafts.
• This approach has the potential to increase organ availability and improve clinical decision-making in liver transplantation.
• NMP is particularly valuable in regions facing limited donor organ supply.