ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Advanced Search

Effectiveness Of The Vittal Viability Criteria During Ex Situ Normothermic Machine Perfusion To Discriminate Hepatobiliary Organ Injury And Investigation Of Biochemical Markers For Post-transplant Complications

Y. L. Boteon, R. Laing, J. Attard, L. Wallace, A. Smith, M. Perera, D. Mirza, H. Mergental, S. Afford

Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom

Meeting: 2019 American Transplant Congress

Abstract number: A185

Keywords: Donors, marginal, Liver preservation, Liver transplantation, Machine preservation

Session Information

Date: Saturday, June 1, 2019

Session Name: Poster Session A: Donor Management: All Organs Excluding Kidney

Session Time: 5:30pm-7:30pm

 Presentation Time: 5:30pm-7:30pm

Location: Hall C & D

Related Abstracts
  • Viability Testing and Transplantation of Marginal Donor Livers (VITTAL) Trial Outcomes: Proteomic Analysis of Perfusates from Livers Undergoing Normothermic Machine Liver Perfusion Reveals Biomarkers Predictive of Graft Viability and Post-Transplant Complications
  • Viability Testing and Transplantation of Marginal Donor Livers (VITTAL) Trial: Metabolomics of Ex Vivo Normothermically Machine Perfused Livers Discloses Molecular Signatures Predictive of Graft Viability and Post Transplant Outcomes

*Purpose: The VITTAL (viability testing and transplantation of marginal livers) clinical trial demonstrated that ex situ end-ischaemic normothermic machine perfusion (NMP) allows functional assessment and transplantation of a large proportion of currently unutilised high-risk donor livers. This study aims to assess whether achievement of the VITTAL criteria for transplantability during NMP correlates with hepatobiliary injury and post-transplant outcomes.

*Methods: The transplantability of discarded high-risk donor livers was assessed during 4 hours of NMP using predefined viability criteria, consisting of: perfusate lactate levels ≤2.5mmol/L, presence of bile production, perfusate pH >7.30, metabolism of glucose, stable vascular arterial flow ≥150mL/min and portal vein flow ≥500mL/min. The livers were supplied with taurocholic acid and the perfusion performed on the OrganOx Metra® device. Perfusate transaminases, bile production and bile properties were assessed and correlated with post-operative clinical complications including ischemic-type biliary lesions (ITBL), early-allograft dysfunction (EAD) and post-reperfusion syndrome (PRS).

*Results: Twenty-two out of thirty-one (71%) livers meet the criteria and were transplanted. Livers deemed non-transplantable during NMP exhibits higher release of transaminases in the perfusate, suggesting more severe hepatobiliary injury (peak ALT -median[Interquartile range]- 9,667[4,600-20,505]vs. 2,410[1,130-4,832]IU/L, p<0.001; peak AST 14,033[5,902-28,436]vs. 4,760[2,316-6,533]IU/L, p=0.001; peak GGT 142[66-527]vs. 118[82-174]IU/L, p=0.051). Although the perfusate transaminase levels do not distinguish cases of PRS, EAD or ITBL post-transplantation, the peak ALT correlates with the recipients’ peak ALT ([Spearman’s]r=0.445, p=0.063). Eight patients (36%) developed ITBL on imaging within 180-days post-transplantation. Whilst bile production does not correlate with ITBL, bile pH <7.85 differentiates patients that developed ITBL (AUROC=0.836[95%CI:0.568->0.999], Sensitivity=91%, Specificity=80%, p=0.036).

*Conclusions: Viability assessment of high-risk donor livers during NMP using the VITTAL criteria might prevent transplantation of organs with severe hepatobiliary damage. Perfusate transaminases do not correlate with post-transplant complications. In the context of NMP with taurocholic acid supplementation, the bile pH cut-off of 7.85 may differentiates livers that develop ITBL following transplantation.

  • Tweet
  • Email
  • Print

To cite this abstract in AMA style:

Boteon YL, Laing R, Attard J, Wallace L, Smith A, Perera M, Mirza D, Mergental H, Afford S. Effectiveness Of The Vittal Viability Criteria During Ex Situ Normothermic Machine Perfusion To Discriminate Hepatobiliary Organ Injury And Investigation Of Biochemical Markers For Post-transplant Complications [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/effectiveness-of-the-vittal-viability-criteria-during-ex-situ-normothermic-machine-perfusion-to-discriminate-hepatobiliary-organ-injury-and-investigation-of-biochemical-markers-for-post-transplant-com/. Accessed April 15, 2021.

« Back to 2019 American Transplant Congress

Most Viewed Abstracts

  • This Week
  • This Month
  • All Time
      • Direct Oral Anticoagulation Use in Kidney Transplant Recipients

      Visit Our Partner Sites

      American Transplant Congress (ATC)

      Visit the official site for the American Transplant Congress »

      American Journal of Transplantation

      The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

      American Society of Transplantation (AST)

      An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

      American Society of Transplant Surgeons (ASTS)

      The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

      Copyright © 2013-2021 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

      Privacy Policy | Terms of Use

      loading Cancel
      Post was not sent - check your email addresses!
      Email check failed, please try again
      Sorry, your blog cannot share posts by email.
      This site uses cookies: Find out more.