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A procedure assessed by NICE has been hailed as an exciting development in increasing the number of donor livers which can be safely used for transplantation.
A perfusion machine can keep the donated liver viable for transplantation for longer. The machine reduces the rate of tissue deterioration that occurs after the liver has been removed from the donor and extends how long the liver can be stored before transplantation.
Variations of the technique can also allow the liver to be flushed with blood at body temperature and supplied with oxygen, medications and nutrients allowing its viability and function to be assessed.
It is hoped machine perfusion could increase the number of organs viable for transplant, saving more lives and reducing liver transplant waiting lists.
Liver transplantation is a highly successful treatment for end-stage liver disease, which kills 11,000 people a year in England. Deaths from liver disease have soared by 25% in a decade and continue to rise, while the average age of death from liver disease (currently 50-59 years) continues to decrease.
NICE has issued final guidance which recommends the procedure ex-vivo machine perfusion for extracorporeal preservation of livers for transplantation is used under special arrangements as more data is gathered into its efficacy.
NICE’s independent advisory committee did not identify any major safety concerns.
Surgeons undertaking the procedure must inform patients about the uncertainty of the procedure’s efficacy, comply with the relevant regulatory and legal requirements of the Human Tissue Authority and should enter details about all patients having this procedure into the NHSBT UK transplant registry.
Professor Kevin Harris, programme director and clinical advisor for the Interventional Procedures Programme at NICE, said: This procedure offers hope for patients needing a liver transplant. It offers another way of preserving the liver and assessing whether livers which might have previously been considered unsuitable, can be used safely.
The latest evidence reviewed by a NICE committee concluded that the procedure worked well and was safe to be offered to patients who had been fully informed of the risks and benefits. Clinicians should seek approval from their trust’s management and record all data from the procedure in a database.
By using this procedure, more patients on the organ transplant waiting list could be offered a chance of a transplant and there-by potentially extending their lives.
University of Birmingham professor Darius Mirza, transplant surgeon at University Hospital’s Birmingham NHS Foundation Trust, said: “In the 30 years I’ve been involved with transplantation there have been three or four events which have been game changers and I’m absolutely certain we are looking at a game changer that will change the way we practice organ storage and transplantation.
“It is already changing practice at the centres that have been able to use this technology either within clinical trials or within an expansion of service evaluation.”