Our Summary

This research paper looks at different strategies for preserving livers for transplantation to try and prevent damage to the liver cells, particularly the ones that are part of the bile duct system. Damage to these cells can lead to scarring and poor drainage of bile, which can cause serious problems for the patient and the transplanted liver. One type of damage, known as ischemic type biliary lesions (ITBL), can happen even when the main artery to the liver is unblocked, and is linked to issues with the smaller blood vessels in the liver. The length of time the liver is without a normal blood supply seems to influence the chances of ITBL occurring.

The paper looks at three commonly used machine perfusion (MP) techniques, which are methods used to keep the liver cells supplied with oxygen to try and prevent damage. These methods are abdominal normothermic regional perfusion (A-NRP), hypothermic oxygenated perfusion (HOPE), and normothermic machine perfusion (NMP).

The paper finds that the evidence suggests that both HOPE and A-NRP can prevent ITBL in livers donated after the donor’s heart has stopped beating, compared to just keeping the liver cold. However, the evidence is not strong for preventing ITBL in livers donated after the donor has been declared brain dead using any of these machine perfusion techniques. It is also hard to compare the different studies because they use different definitions of ITBL and different techniques.

FAQs

  1. What is ischemic type biliary lesions (ITBL) and how does it affect liver transplantation?
  2. What are the three commonly used machine perfusion techniques discussed in the research paper and how do they help in preserving liver cells?
  3. Does the research indicate any difference in the effectiveness of machine perfusion techniques in preventing ITBL between livers donated after cardiac death and those donated after brain death?

Doctor’s Tip

One helpful tip a doctor might tell a patient about liver transplant is to be aware of the importance of preserving the liver during the transplant process. It is important for patients to discuss with their healthcare team the use of machine perfusion techniques, such as abdominal normothermic regional perfusion (A-NRP) and hypothermic oxygenated perfusion (HOPE), to help prevent damage to the liver cells and reduce the risk of complications post-transplant. Patients should also be informed about the potential risks and benefits of these techniques, and how they can impact the success of the transplant. Being knowledgeable about these preservation strategies can help patients make informed decisions and improve their overall outcome following a liver transplant.

Suitable For

Patients who are typically recommended for liver transplant are those with end-stage liver disease, acute liver failure, or liver cancer that cannot be treated with other methods. Patients with chronic liver diseases such as cirrhosis, hepatitis C, or alcohol-related liver disease may also be candidates for liver transplant if their condition is severe and cannot be managed with medication or other treatments. The decision to recommend a liver transplant is made by a team of healthcare professionals who consider the patient’s overall health, the severity of their liver disease, and their likelihood of benefiting from a transplant.

Timeline

Before the liver transplant:

  • Patient is diagnosed with end-stage liver disease and referred for liver transplant evaluation.
  • Patient undergoes extensive medical and psychological evaluations to determine if they are a suitable candidate for a liver transplant.
  • Patient is placed on the transplant waiting list and waits for a suitable donor liver to become available.
  • Patient may experience worsening symptoms of liver disease, such as jaundice, fatigue, and swelling.
  • Patient may undergo various treatments to manage symptoms and complications of liver disease.

After the liver transplant:

  • Patient undergoes the liver transplant surgery, which can take several hours.
  • Patient is closely monitored in the intensive care unit (ICU) immediately after surgery.
  • Patient may experience pain, nausea, and other side effects of surgery.
  • Patient begins a regimen of immunosuppressive medications to prevent rejection of the donor liver.
  • Patient undergoes regular follow-up appointments and monitoring to ensure the success of the transplant.
  • Patient may experience complications such as infection, rejection, or graft failure, which may require additional treatment.
  • Patient gradually recovers and resumes normal activities, with the goal of returning to a healthy and active lifestyle.

What to Ask Your Doctor

Some questions a patient should ask their doctor about liver transplant include:

  1. What is the likelihood of developing ischemic type biliary lesions (ITBL) after a liver transplant?
  2. What machine perfusion techniques will be used to preserve the liver during transplantation?
  3. How do these machine perfusion techniques work to prevent damage to the liver cells?
  4. What are the potential risks and benefits of using machine perfusion techniques during liver transplantation?
  5. How does the length of time without a normal blood supply to the liver impact the development of ITBL?
  6. Are there any alternative methods or treatments available to prevent ITBL after a liver transplant?
  7. What is the success rate of preventing ITBL using machine perfusion techniques in livers donated after the donor’s heart has stopped beating?
  8. How will the doctor monitor and assess the health of the liver post-transplant to detect any potential complications, such as ITBL?
  9. What is the doctor’s experience and expertise in performing liver transplants and using machine perfusion techniques?
  10. Are there any clinical trials or research studies available that focus on improving outcomes and reducing complications, such as ITBL, in liver transplant patients?

Reference

Authors: Durán M, Calleja R, Hann A, Clarke G, Ciria R, Nutu A, Sanabria-Mateos R, Ayllón MD, López-Cillero P, Mergental H, Briceño J, Perera MTPR. Journal: World J Gastroenterol. 2023 May 28;29(20):3066-3083. doi: 10.3748/wjg.v29.i20.3066. PMID: 37346149