Viability Outcomes for Donor Livers Discarded Due to Steatosis Following Extra-Corporeal Machine Perfusion of the Liver
1National Institute for Health Research, Birmingham Liver Biomedical Research Centre, University of Birmingham, Institute of Immunology and Immunotherapy, Birmingham, United Kingdom
2Liver Unit, Queen Elizabeth Hospital, University Hospitals Birmingham, Birmingham, United Kingdom.
Meeting: 2018 American Transplant Congress
Abstract number: D60
Keywords: Donors, Liver transplantation, Machine preservation, marginal
Session Information
Session Name: Poster Session D: Ischemia Reperfusion Injury: Time to Change the Fate?
Session Type: Poster Session
Date: Tuesday, June 5, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background: Steatosis is the main reason for discarding donor livers worldwide. Ex-vivo machine perfusion offers superior preservation for marginal organs and permits viability testing during normothermic machine perfusion (NMP). Short-term hypothermic machine perfusion (HMP) was shown to improve the function of marginal organs. We aimed to analyse the outcomes of human livers declined based on surgical macroscopic assessment (SMA) of steatosis submitted to NMP alone or a merged protocol of HMP and NMP.
Methods: we perfused 33 donor livers discarded for transplantation after SMA of steatosis and a period of cold storage using NMP alone for 6 hours or a combined protocol of HMP for 2 hours followed by 4 hours of NMP. Viability was assessed at the end of NMP using our lactate clearance criteria. Liver tissue for histology and perfusate were sampled throughout. Assessment of macrosteatosis rates was undertaking by an independent pathologist on paraffin sections (<5% macrosteatosis [MS]: absent; 5-30% MS: mild; 30-60%: moderate; >60%: severe).
Results: Out of 33 livers discarded for steatosis, this was completely absent in 12 (36%) organs, 10 (30%) showed mild MS, 7 (21%) moderate MS and 4 (12%) severe MS. Functional assessment revealed the steatotic livers were less likely to achieve viability (5/21, 15% compared to 6/12, 50%, p=0.049). Within the steatotic livers subgroup, 11/21 (52%) were included in NMP and 10/21 (48%) in HMP+NMP group. All NMP livers (100%) failed to reach viability (5[HM1] mild, 3 moderate and 2 severe MS) compared unfavourably to 5 (50%) viable livers (p=0.006) in the HMP+NMP group (2 mildly and 3 moderately livers). All severely steatotic livers failed to reach viability criteria regardless the perfusion protocol.
Conclusion: This study confirmed that surgical assessment does not closely correlate with histological macrosteatosis evaluation. Steatotic livers often fail to achieve viability on end-ischemic NMP alone and may require additional intervention. HMP prior to NMP may be a potential approach to increase the rescue of mildly to moderately steatotic livers during NMP.
CITATION INFORMATION: Boteon Y., Laing R., Neil D., Schlegel A., Attard J., Reynold G., Muiesan P., Mirza D., Afford S., Mergental H. Viability Outcomes for Donor Livers Discarded Due to Steatosis Following Extra-Corporeal Machine Perfusion of the Liver Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Boteon Y, Laing R, Neil D, Schlegel A, Attard J, Reynold G, Muiesan P, Mirza D, Afford S, Mergental H. Viability Outcomes for Donor Livers Discarded Due to Steatosis Following Extra-Corporeal Machine Perfusion of the Liver [abstract]. https://atcmeetingabstracts.com/abstract/viability-outcomes-for-donor-livers-discarded-due-to-steatosis-following-extra-corporeal-machine-perfusion-of-the-liver/. Accessed May 9, 2025.« Back to 2018 American Transplant Congress