Surgical Innovations
Liver transplantation
Better preservation of donor organs may enable more transplants
Dr. Guarrera examines a donated liver that has been stored with machine preservation. |
As advanced as the field of organ transplantation has become, several important challenges remain.
Of these, the availability of donor organs stands paramount.
Among those with end stage liver disease, over 17,000 patients wait for a donated liver every year in the U.S., but fewer than 6000 receive one, and about 1800 people die while on the waiting list.
As a result, researchers are avidly working to find ways to safely use as many potential donor organs as possible, including organs that once may have been considered "imperfect."
According to James V. Guarrera, MD, Assistant Professor of Surgery, Division of Abdominal Organ Transplantation, many new techniques are being investigated to broaden the range of organs considered acceptable for transplantation.
Some of these methods increase the time that organs may be preserved and prevent organ injury associated with being outside the body.
These are important advances, according to Dr. Guarrera, because problems with the donor organ may lead to poor function or failure of the transplant.
Until recently, however, these approaches have not been applied to donor livers.
In the only U.S. study of its kind to date, Dr. Guarrera is researching the use of machine preservation
to more effectively store livers before transplantation.
He explains that in machine preservation, cold preservation solution is continuously circulated through a donated organ.
This maintains the metabolic processes of the organ, which keeps it healthy prior to transplantation and prevents injury that might cause problems later.
James V. Guarrera, MD |
Jean Emond, MD |
"In kidney transplantation, the use of machine preservation has become standard practice in many parts of the country," Dr. Guarrera says, "because transplanted organs are more successful after this method compared to the older method of preserving organs."
In the traditional method of cold storage, donor organs are simply submerged in cold preservation solution.
The lack of active circulation through the organ causes some damage, and it limits the time that such organs may be stored.
Because machine preservation actively circulates metabolic substrates, the organ stays healthier longer and does not undergo the same kind of damage.
In light of organ preservation successes with kidney transplantation, Dr. Guarrera hypothesized that machine preservation might similarly enhance outcomes in liver transplantation and allow the safe use of more organs.
This preliminary study is the first to test the safety of machine preservation in human liver transplants.
As Principal Investigator of the trial, Dr. Guarrera has tremendous support from his colleagues on the surgical team led by Jean Emond, MD and from perfusionist Ben Arrington.
In addition, Dr Guarrera is collaborating with H.T. Lee, MD, PhD, a research clinician in the Department of Anesthesiology, to study the basic science underlying the method of machine preservation.
"Our hope is that this work may pave the way for safer transplantation of more patients in the future," says Dr. Guarrera.
For more information, please call 855-CUSURGE.
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