By giving donor livers special treatment at the UMCG, the organs remain good for much longer. This has all kinds of advantages. Not least, a more equipped transplant team.
Time has traditionally been the great enemy in a liver transplant. Once outside the body, a donor liver remains good for 6 to 10 hours. When a donor liver becomes available, transplant surgeons and patients have to rush to the operating room. Very often this means that the liver transplants, which take an average of 10 hours, are started in the middle of the night.
Research from the UMCG that was published today in the medical scientific journal The Lancet is published, shows that this method is no longer necessary. By storing the organ in a so-called perfusion machine, in which it is cooled and treated with an oxygen-rich fluid, the liver remains good for much longer and the quality of the organ is even improved.
No complications
The UMCG research shows that no complications occurred that were due to the longer storage period. The conclusion is that the method is as safe for patients as traditional emergency surgery, which is still used in all transplant centers in the world. Thanks to this research into the new, extended perfusion technique, the UMCG transplant team has performed 79 of the 83 liver transplants during the day last year, usually from 9 a.m. to 5 p.m.
This is very good news for several reasons, says Vincent de Meijer, professor of surgery and head of the liver transplant program at the UMCG. “The operations become much easier to plan,” says De Meijer. “It means that a patient does not have to drop everything to go to the hospital, but can be scheduled for the operation the next morning without stress.”
‘Works much better’
The same applies to the team that has to carry out the operation. “We are all trained to be able to do this work properly, even in the middle of the night. But I worked the day before, put my children to bed in the evening and obviously couldn’t sleep for very long. It is safe, but I am slower at night than during the day.” The research also shows that daytime operations take an average of two hours less than operations performed at night. “I had a liver transplant on Saturday that was outside the body for 26 hours. We started rested at 9 a.m. and that really works a lot better than in the middle of the night.”
Because planning can be done, slightly more patients can receive a liver transplant in the UMCG. Previously, two donor livers sometimes became available at the same time and one liver was lost, because the team can only perform one operation at a time.
Only center in the world
Another advantage is that colleagues do not have to be paged in the event of complications or unexpected events during operations. “Because they are already in the hospital during the day,” says De Meijer. “It leads to fitter operating teams and therefore makes an important contribution to the sustainable employability of everyone involved.”
The threshold for a combined heart-liver transplant and lung-liver transplant is also lower. “Because the liver can be safely stored for a longer period of time, the heart or lung transplant can be performed first. We can then perform the liver transplant without time pressure.”
The UMCG is so far the only center in the world that uses this method of extended machine perfusion to perform standard liver transplants during the day. De Meijer expects this to be the case through the publication in The Lancet is going to change quickly. “The field is really looking forward to this.”