Damaged liver is repaired and transplanted in patient

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A team of doctors have successfully repaired a damaged liver and transplanted it into a patient- all thanks to a machine they developed.

The damaged liver was taken from a patient who had had sepsis, and put into the machine. The machine is called an integrated perfusion machine, and for the next three days it kept the liver alive, whilst it repaired and regenerated. Inside the machine the environment has been created to simulate the environment an actual liver would live in the body. The liver sits atop an artificial diaphragm, which mimics the movement. There are tubes for oxygen and nutrients, and donated blood, which are fed to the liver at the pressure and temperature found in the human body.

“We give everything to this liver to keep it happy, in a way that the liver doesn’t know it is outside of the body,’ says Pierre-Alain Clavien of the University Hospital Zurich, Switzerland.

There are currently more people waiting for livers than available livers. According to the NHS website the average waiting time for a liver transplant is 145 days for adults and 72 days for children. Strict tests are performed on livers before they are deemed suitable for transplant.

The sepsis-damaged liver repaired by Clavien was not considered a suitable candidate under current guidelines for transplant. The donor liver also had a small lesion on it.

‘If this organ was not used, it would have been put in the trash,’ Clavien said.

Currently, livers can only be stored outside of the body for 12 hours. The integrated perfusion machine’s environment allows the liver to be kept for ten days before being transplanted. That in itself takes the pressure off a time-sensitive procedure, where the patient must be quickly ready for surgery.

To make the liver transplant-ready, the team administered a high dose of antibiotics to clear any infection in the liver. They were able to test the lesion to see if it was cancerous (it wasn’t), which would not be possible in the 12-hour time frame of a traditional transplant.

The patient that received the liver was a 63 year-old man with advanced cirrhosis and cancer. The patient’s condition was so advanced that it is unlikely he would have survived long enough to wait for a donor liver. He agreed to the experimental procedure, and following surgery was discharged only a few days later.

It has now been over a year since the surgery, and the patient expressed his thanks for the procedure.

“I am very grateful for the life-saving organ,” said the patient. “Due to my rapidly progressing tumor, I had little chance of getting a liver from the waiting list within a reasonable period of time.”

Image from USZ

The future looks promising thanks to the integrated perfusion machine. In an interview in 2020 with Future Medicine, Clavien explains the machine may be able to help people grow healthy parts of their own livers.

“This implication would enable us to take a small healthy part of a liver from patients with advanced liver tumors, and have this part of the liver grow on the machine,” Clavien said. He added,

“In this ideal scenario, after regeneration on the machine, we could remove the entire liver containing the cancer and replace it with the regrown healthy liver.”

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