Ensuring liver transplants despite steatosis

Normothermic perfusion can be used to decrease total liver fat

Researchers at Oxford University, UK, evaluated the impact of normothermic mechanical perfusion and anti-lipid adjuvants on human steatosis livers and studied how grafts could be improved to enable successful transplantation.

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Transplantation of steatosic livers has poor results. As a result, many of these organs are now being discarded, thus reducing the number of organs available for transplantation. On the other hand, the global obesity epidemic is likely to increase the proportion of steatosis livers in the donor pool. The lack of suitable livers will cause the death of many patients waiting for the transplant.  A solution could come from normothermic mechanical perfusion, a method that keeps the liver in a fully functioning state ex-situ, allowing oxygen and nutrition to be supplied at 37 °C.

Data from a new study recently presented at the Liver Meeting organized by the American Association for the Study of Liver Diseases (AASLD) confirm that normothermic mechanical perfusion can be used to preserve steatosic livers and to alter their structure and lipid metabolism, resulting in the possibility of a more effective transplant.

Researchers selected 16 human livers refused for transplantation because of steatosis. The livers were perfused for 48 hours on a normal-thermal circuit with blood and oxygen. The livers were divided into three groups: 6 were only perused and oxygenated, 5 were subjected to normothermic perfusion and lipid apheresis, 5 were treated with perfusion, lipid apheresis, and delipidizing agents. Donor characteristics and total levels of pre-perfusion steatosis were similar among the three liver groups. All livers have shown similar metabolic and synthetic functions, ensuring valid comparisons.

The researchers found that the addition of a lipid apheresis filter to the normothermic perfusion led in 48 hours to a significant reduction in circulating triglycerides compared to the use of normothermic perfusion alone. There was also a significant reduction in the total cholesterol perfused.

In the livers to which delipidising agents have been added, there has been an increase in the oxidation of fatty acids compared to the other two groups. This group of livers also showed an average reduction in the level of tissue triglycerides.

The results of the study show that the normal-thermal storage of steatosic livers for 48 hours results in altered lipid structure and metabolism in the organs, potentially leading to more effective transplants.

Normothermic Machine Perfusion Can Salvage Fatty Livers for Transplantation. AASLD. https://www.aasld.org/about-aasld/press-room/normothermic-machine-perfusion-can-salvage-fatty-livers-transplantation

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