Perfusion Machine Stores Organs Outside Body for Days Before Transplantation

For the first time in the history of medicine, a multidisciplinary research team has successfully treated an originally damaged human liver in a machine for three days outside a body and then implanted the recovered organ into a cancer patient. One year later, the patient is doing well.

The extraordinary feat was achieved thanks to a perfusion machine developed in house by a research team at the Liver4Life project under the umbrella of the University of Zurich (Zurich, Switzerland), making it possible to implant a human organ into a patient after a storage period of three days outside a body. In January 2020, the multidisciplinary research team had demonstrated for the first time that perfusion technology makes it possible to store a liver outside the body for several days. The machine mimics the human body as accurately as possible, in order to provide ideal conditions for the human livers. A pump serves as a replacement of the heart, an oxygenator replaces the lungs and a dialysis unit takes over the functions of the kidneys. In addition, numerous hormone and nutrient infusions perform the functions of the intestine and pancreas. Like the diaphragm in the human body, the machine also moves the liver to the rhythm of human breathing.

Image: For the first time, a human liver was treated in a machine and then successfully transplanted (Photo courtesy of University of Zurich)

The team prepared the liver in the machine with various drugs. In this way, it was possible to transform the liver into a good liver graft, even though it was originally not approved for transplantation. Perfusion over several days, i.e. the mechanical perfusion of the organ, enables, for example, antibiotic or hormonal therapies or the optimization of liver metabolism. In addition, lengthy laboratory or tissue tests can be carried out without time pressure. Under normal circumstances, this is not possible because organs can only be stored for 12 hours if they are stored conventionally on ice and in commercially available perfusion machines. As part of an approved individual treatment attempt, the doctors gave a cancer patient on the Swiss transplant waiting list the choice of using a treated human liver. Following his consent, the organ was transplanted in May 2021. The patient was able to leave hospital a few days after the transplantation and is now doing well.

The next step in the Liver4Life project is to review the procedure on other patients and to demonstrate its efficacy and safety in the form of a multicenter study. Its success would mean that in the future, a liver transplantation, which usually constitutes an emergency procedure, would be transformed into a plannable elective procedure. At the same time, a next generation of machines is being developed. In addition, those involved in basic research continue to look for ways of treating other liver diseases outside the body with drugs, molecules or hormones.

“Our therapy shows that by treating livers in the perfusion machine, it is possible to alleviate the lack of functioning human organs and save lives,” said Prof. Pierre-Alain Clavien, Director of the Department of Visceral Surgery and Transplantation at the University Hospital Zurich (USZ).

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