• Matteo Mueller, Max Hefti, Dilmurodjon Eshmuminov, Martin J Schuler, Sousa Da SilvaRichard XRXWyss Zurich, ETH Zurich/University of Zurich, Switzerland.Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Switzerland., Henrik Petrowsky, Michelle L De Oliveira, Christian E Oberkofler, Catherine Hagedorn, Leandro Mancina, Achim Weber, Brian Burg, Mark W Tibbitt, Rudolf von RohrPhilippPWyss Zurich, ETH Zurich/University of Zurich, Switzerland.Transport Processes and Reactions Laboratory, Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland., Philipp Dutkowski, Dustin Becker, Bautista BorregoLuciaLWyss Zurich, ETH Zurich/University of Zurich, Switzerland.Department of Surgery and Transplantation, Swiss Hepato-Pancreato-Biliary (HPB) Center, University Hospital Zurich, Switzerland., and Pierre-Alain Clavien.
• Wyss Zurich, ETH Zurich/University of Zurich, Switzerland.
• Ann. Surg. 2021 Nov 1; 274 (5): 836-842.

ObjectiveThe aim of this study was to maintain long-term full function and viability of partial livers perfused ex situ for sufficient duration to enable ex situ treatment, repair, and regeneration.BackgroundOrgan shortage remains the single most important factor limiting the success of transplantation. Autotransplantation in patients with nonresectable liver tumors is rarely feasible due to insufficient tumor-free remnant tissue. This limitation could be solved by the availability of long-term preservation of partial livers that enables functional regeneration and subsequent transplantation.MethodsPartial swine livers were perfused with autologous blood after being procured from healthy pigs following 70% in-vivo resection, leaving only the right lateral lobe. Partial human livers were recovered from patients undergoing anatomic right or left hepatectomies and perfused with a blood based perfusate together with various medical additives. Assessment of physiologic function during perfusion was based on markers of hepatocyte, cholangiocyte, vascular and immune compartments, as well as histology.ResultsFollowing the development phase with partial swine livers, 21 partial human livers (14 right and 7 left hemi-livers) were perfused, eventually reaching the targeted perfusion duration of 1 week with the final protocol. These partial livers disclosed a stable perfusion with normal hepatic function including bile production (5-10 mL/h), lactate clearance, and maintenance of energy exhibited by normal of adenosine triphosphate (ATP) and glycogen levels, and preserved liver architecture for up to 1 week.ConclusionThis pioneering research presents the inaugural evidence for long-term machine perfusion of partial livers and provides a pathway for innovative and relevant clinical applications to increase the availability of organs and provide novel approaches in hepatic oncology.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

22 keywords...

hide…