Image: For the first time, a human liver has been processed in a machine and then successfully transplanted (Photo courtesy of the University of Zurich)
For the first time in the history of medicine, a multidisciplinary research team successfully treated an initially damaged human liver in a machine for three days outside of a body, then implanted the recovered organ into a cancer patient. A year later, the patient is doing well.
The extraordinary feat was achieved thanks to an infusion machine developed in-house by a research team from the Liver4Life project under the aegis of the University of Zurich (Zurich, Switzerland), allowing a human organ to be implanted in a patient. after a storage period of three days outside a body. In January 2020, the multidisciplinary research team demonstrated for the first time that perfusion technology makes it possible to store a liver outside the body for several days. The machine mimics the human body as closely as possible, to provide ideal conditions for the human liver. A pump replaces the heart, an oxygenator replaces the lungs and a dialysis unit takes over the functions of the kidneys. In addition, many infusions of hormones and nutrients 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.
The team prepared the liver in the machine with various drugs. In this way, it was possible to turn the liver into a good liver transplant, even though it was not originally approved for transplantation. Perfusion over several days, ie the mechanical perfusion of the organ, allows for example antibiotic or hormonal therapies or the optimization of hepatic metabolism. In addition, lengthy laboratory or tissue tests can be performed without time pressure. Under normal circumstances this is not possible as organs can only be stored for 12 hours if stored conventionally on ice and in commercially available infusion machines. As part of an approved individual treatment attempt, doctors gave a cancer patient on the Swiss waiting list for a transplant the choice to use a treated human liver. Following his consent, the organ was transplanted in May 2021. The patient was able to leave the hospital a few days after the transplant and is now doing well.
The next step of the Liver4Life project is to review the procedure on other patients and demonstrate its efficacy and safety in the form of a multicenter study. Its success would mean that in the future, a liver transplant, which is usually an emergency procedure, would be transformed into a plannable elective procedure. At the same time, a new generation of machines is being developed. In addition, basic research actors continue to seek ways to treat other liver diseases outside the body with drugs, molecules or hormones.
“Our therapy shows that by treating the livers in the perfusion machine, it is possible to overcome the lack of functional human organs and save lives,” said Prof. Pierre-Alain Clavien, director of the visceral surgery department. and transplant at the CHU. Zürich (USZ).
University of Zurich