The multidisciplinary Zurich research team Liver4Life has succeeded in doing something during a treatment attempt that had never been achieved in the history of medicine until now: it treated an originally damaged human liver in a machine for three days outside of a body and then implanted the recovered organ into a cancer patient. One year later, the patient is doing well.
From: University of Zurich
May 31, 2022 -- The
Liver4Life research team owes its perfusion machine, which was developed in
house, to the fact that it became possible to implant a human organ into a
patient after a storage period of three days outside a body. 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 heart, an oxygenator
replaces the lungs and a dialysis unit performs 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. In January 2020,
the multidisciplinary Zurich research team – involving the collaboration of
University Hospital Zurich (USZ), ETH Zurich and the University of Zurich (UZH)
– demonstrated for the first time that perfusion technology makes it possible
to store a liver outside the body for several days. Press release
13.1.20
From poor to good in
three days
The team prepared the
liver in the machine with various drugs. In this way, it was possible to
transform the liver into a good human organ, even though it was originally not
approved for transplantation due to its poor quality. The multi-day perfusion,
i.e. the mechanical circulation of the organ, enables antibiotic or hormonal
therapies or the optimization of liver metabolism, for example. 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.
Treatment attempt
successful
As part of an approved
individual treatment attempt, the doctors gave a cancer patient on the
Swisstransplant waiting list the choice of using the 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: “I am very grateful for the life-saving organ. Due to my rapidly
progressing tumor, I had little chance of getting a liver from the waiting list
within a reasonable period of time.”
Saving more lives
The article on the
first transplantation of a liver prepared in a perfusion machine was published
in one of the most renowned scientific journals, Nature Biotechnology, on 31
May 2022. “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,” explains Pierre-Alain Clavien, director of the Department of Visceral
Surgery and Transplantation at the University Hospital Zurich (USZ). Mark
Tibbitt, professor of macromolecular engineering at ETH Zurich, adds: “The
interdisciplinary approach to solving complex biomedical challenges embodied in
this project is the future of medicine. This will allow us to use new findings
even more quickly for treating patients.”
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.
Literature:
Clavien PA, Dutkowski P
et al. Transplantation of a human liver following 3 days of ex situ
normothermic preservation. Nature Biotechnology. Mai 31, 2022. DOI: 10.1038/s41587-022-01354-7
https://www.media.uzh.ch/en/Press-Releases/2022/Liver-Transplantation.html
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