Our Summary

This research paper is about the use of a technique called machine perfusion (MP) in liver transplants. Machine perfusion is a process that keeps donated organs in a better condition which extends the time they can be stored before being transplanted. This technology has been used more and more over the past 20 years and has now become standard practice. It has been found to be safe and can potentially improve the outcomes of the transplant.

An important benefit of this technique is that it allows for the use of livers that were previously considered too risky for transplantation. However, the actual use of this technique in these cases varies.

In response to this, the European Liver and Intestine Transplant Association (ELITA) gathered a group of experts to create guidelines on how to assess whether a liver is suitable for transplantation in the era of machine perfusion. They put together a committee of experts from 14 countries in Europe and North America.

The committee identified various topics related to the use of livers for transplantation and created a list of questions to be addressed. They then reviewed existing research on these topics and used this to draft initial statements. These statements were then presented at a meeting and voted on by the experts. If 85% or more of the experts agreed with a statement, it was approved.

The agreed statements provide guidance on how to use livers for transplantation, how to define high-risk livers, and how to assess liver suitability dynamically.

FAQs

  1. What is machine perfusion (MP) and how does it aid in liver transplants?
  2. How does the use of machine perfusion change the criteria for a liver being suitable for transplantation?
  3. What was the purpose of the guidelines created by the European Liver and Intestine Transplant Association (ELITA) and how were they developed?

Doctor’s Tip

One helpful tip that a doctor might tell a patient about liver transplant is to follow a healthy lifestyle post-transplant. This includes maintaining a balanced diet, staying active, avoiding alcohol and tobacco, and taking any prescribed medications as directed. It is important to take care of your new liver to ensure its long-term success.

Suitable For

Patients who are typically recommended for liver transplant include those with end-stage liver disease, acute liver failure, or certain liver cancers that cannot be treated effectively with other methods. These patients often have a poor prognosis without a transplant and may have a high risk of mortality within a short period of time.

In addition, patients with certain genetic or metabolic disorders that affect the liver, such as hemochromatosis or Wilson’s disease, may also be recommended for a liver transplant. These conditions can lead to liver failure if left untreated and may require a transplant to prevent further complications.

Patients with chronic liver diseases, such as cirrhosis or hepatitis C, may also be candidates for a liver transplant if their condition has progressed to a point where other treatments are no longer effective. These patients may experience symptoms such as jaundice, ascites, or hepatic encephalopathy, which can significantly impact their quality of life.

Overall, the decision to recommend a liver transplant for a patient is based on a thorough evaluation of their medical history, current health status, and prognosis. The use of machine perfusion in liver transplants has expanded the pool of potential donors and allowed for the transplantation of livers that were previously considered too risky. This has the potential to improve outcomes for patients in need of a transplant and increase the availability of donor organs.

Timeline

Before a liver transplant, a patient typically goes through a series of tests and evaluations to assess their overall health and determine if they are a suitable candidate for the procedure. This process can take several weeks to months and may involve consultations with various specialists, such as hepatologists, surgeons, and psychologists. Once a patient is deemed eligible for a liver transplant, they are placed on a waiting list for a compatible donor organ.

After receiving a liver transplant, the patient undergoes a period of recovery in the hospital, which can last for several weeks. During this time, they are closely monitored for any signs of organ rejection or complications. After being discharged from the hospital, the patient will need to continue taking immunosuppressant medications to prevent rejection of the new liver. They will also need to attend regular follow-up appointments with their transplant team to monitor their progress and adjust their medication as needed.

Overall, the timeline for a liver transplant patient can vary depending on individual circumstances, but the goal is to ensure a successful transplant and long-term health for the patient.

What to Ask Your Doctor

Some questions a patient should ask their doctor about liver transplant in the era of machine perfusion include:

  1. What is machine perfusion and how does it improve the outcomes of liver transplant?
  2. How does machine perfusion impact the availability of livers for transplantation?
  3. How will the use of machine perfusion affect the criteria for determining whether a liver is suitable for transplantation?
  4. What are the risks and benefits of using a liver that was previously considered too risky for transplantation with machine perfusion?
  5. How will the use of machine perfusion impact the success rates of liver transplant procedures?
  6. What is the experience of the transplant center with using machine perfusion in liver transplants?
  7. What is the process for evaluating whether a liver is suitable for transplantation with machine perfusion?
  8. How will the use of machine perfusion affect the waiting time for a liver transplant?
  9. Are there any specific considerations or precautions to take when receiving a liver transplant with machine perfusion?
  10. What are the long-term outcomes and potential complications associated with receiving a liver transplant with machine perfusion?

Reference

Authors: Hessheimer AJ, Hartog H, Marcon F, Schlegel A, Adam R, Alwayn I, Angelico R, Antoine C, Berlakovich G, Bruggenwirth I, Calatayud D, Cardini B, Cillo U, Clavien PA, Czigany Z, De Carlis R, de Jonge J, De Meijer VE, Dondossola D, Domínguez-Gil B, Dutkowski P, Eden J, Eshmuminov D, Fundora Y, Gastaca M, Ghinolfi D, Justo I, Lesurtel M, Leuvenink H, Line PD, Lladó L, López López V, Lurje G, Marín LM, Monbaliu D, Muller X, Nadalin S, Nasralla D, Oniscu G, Patrono D, Pirenne J, Selzner M, Toso C, Troisi R, Van Beekum C, Watson C, Weissenbacher A, Zieniewicz K, Schneeberger S, Polak WG, Porte RJ, Fondevila C. Journal: J Hepatol. 2025 Jun;82(6):1089-1109. doi: 10.1016/j.jhep.2025.01.042. Epub 2025 Apr 4. PMID: 40189968