Loosely on the same topic Boxers brought up here, about getting lots of "duty" out of a donated liver .... here's another article where they might get more bang for the buck by how they handle donor livers and by potentially "de-fatting" livers! Man, what good ideas next! I am all for freeing up any potentially good liver for donation!

News · November 13, 2018

AASLD 2018: Fat in Steatotic Donor Livers Can Be Reduced With Machine Perfusion

These livers are then rendered suitable for transplantation.

PracticeUpdate Editorial Team 

November 13, 2018 - San Francisco, California - Normothermic machine perfusion can be used to preserve steatotic livers, leading to altered lipid structure and metabolism that may result in more successful transplantation of these organs.

This conclusion, based on results of a placebo-controlled comparative study, was presented at the 2018 Liver Meeting® of the American Association for the Study of Liver Diseases, from November 9 -13.

Carlo Ceresa, MBChB, MRCS, noted that the amount of de novo lipogenesis fatty acids were significantly decreased in the liver over 48 hours following alteration of glucose and insulin concentrations, which led to decreased liver fat. Furthermore, the addition of l-carnitine led to increased mitochondrial fatty acid oxidation, where the liver uses fatty acids for energy production.

Dr. Ceresa and colleagues set out to evaluate normothermic machine perfusion and de-fatting adjuncts in human steatotic livers, as well as how grafts could be enhanced to enable successful transplantation.

Because many patients die waiting for a liver transplant due to the shortage of suitable donor livers, discovering methods that can facilitate safe and reliable transplantation of higher-risk livers will be beneficial for maximizing the donor pool. Fatty livers contribute to the largest portion of discarded organs; therefore, salvaging these livers for transplantation would be very beneficial.

The researchers selected 16 human livers that had been declined for transplantation due to steatosis. The livers were perfused on a normothermic, oxygenated, blood-based circuit for 48 h.

The livers were divided into three groups: six were perfused with normothermic machine perfusion alone, five were perfused with normothermic machine perfusion + lipid apheresis filtration, and five were perfused with normothermic machine perfusion, lipid apheresis filtration, and defatting agents.

Donor demographics and preperfusion total macrovesicular steatosis levels were similar between all three groups of livers. All livers demonstrated similar patterns of metabolic and synthetic function, ensuring valid comparisons of fat metabolism based on these interventions.

Adding a lipid apheresis filter to normothermic machine perfusion resulted in a significant reduction of circulating triglycerides by 48 h vs normothermic machine perfusion alone.

This reduction was also seen when livers perfused with a lipid apheresis filter and defatting agents were compared with those perfused with normothermic machine perfusion alone.

Livers filtered by lipid apheresis also demonstrated a significant reduction in perfusate total cholesterol vs those perfused with normothermic machine perfusion alone.

In the livers to which defatting agents were added, an increase in median fatty acid oxidation vs the other two groups was observed. This group of livers also showed an average reduction in tissue triglyceride level, a significant finding compared with the other two groups.

The findings demonstrated that normothermic machine preservation of steatotic livers for 48 h altered lipid structure and metabolism. This alteration may result in more successful transplantation of these organs.

Steatotic livers may lead to poor outcomes after transplant and, as a result, many of these organs are discarded. The global obesity epidemic will likely increase the proportion of steatotic livers in the donor pool.

A potential method to salvage these livers for transplantation is normothermic machine perfusion, which maintains the liver in a fully functioning state ex situ, providing oxygen and nutrition at 98.6°F (37°C). This allows functional liver assessment and provides the potential for therapeutic interventions that may optimize the graft.

Dr. Ceresa noted that the next trial will be designed to determine whether clinical outcomes are improved following ex situ interventions on fatty livers. It will also be important to understand whether all steatotic livers can be salvaged. Gene expression analysis may be used to identify additional drug targets for exploration in the process of defatting steatotic livers.

I merged both Donor Organ threads. This way we’re not bouncing back and forth between the two and missing posts. 

I noticed a message Canuck left in the Healio updates thread and thought I would share a little bit more information I found on the topic. The UT Southwestern Medical Center is at the forefront of transplantation and this is another example of their commitment.

Warming Up Technology

Thank you so much for the update, boxers. I didnt realize you had had a transplant! Yowza that is huge! Congrats! Sending healing vibes your way along with prayers and well wishes. 

Hey, it works for me, too!  

That’s an amazing story! It’s the first time I have heard of a retransplanted organ. Now that’s getting some real mileage  

That is a good question! I kind of doubt they would transplant it again, but hey, if it was functioning perfectly and God forbid you had an accident and someone needed it, then I suppose anything is possible. I’m thinking that the useful life of our organs is probably 60ish years for transplantation, maybe more depending on the health of the donor.