Siavash Raigani1,2, Reinier J De Vries2,3, Cailah Carroll2, Ya-Wen Chen1,4, David C Chang4, Stuti G Shroff5, Korkut Uygun1,2, Heidi Yeh1. 1. Division of Transplant Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA. 2. Center for Engineering in Medicine, Massachusetts General Hospital and Shriners Hospital for Children, Boston, MA, USA. 3. Department of Surgery, Amsterdam University Medical Centers, University of Amsterdam, Amsterdam, The Netherlands. 4. Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Boston, MA, USA. 5. Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA.
Abstract
BACKGROUND: Over 700 donor livers are discarded annually in the United States due to high risk of poor graft function. The objective of this study was to determine the impact of using normothermic machine perfusion to identify transplantable livers among those currently discarded. STUDY DESIGN: A series of 21 discarded human livers underwent viability assessment during normothermic machine perfusion. Cross-sectional analysis of the Scientific Registry of Transplant Recipients database and cost analysis was performed to extrapolate the case series to national experience. RESULTS: 21 discarded human livers were included in the perfusion cohort. 11 of 20 (55%) eligible grafts met viability criteria for transplantation. Grafts in the perfusion cohort had a similar donor risk index compared with discarded grafts (n = 1402) outside of New England in 2017 and 2018 (median [IQR]: 2.0 [1.5, 2.4] vs. 2.0 [1.7, 2.3], P = .40). 705 (IQR 677-741) livers were discarded annually in the United States since 2005, translating to the potential for 398 additional transplants nationally. The median cost to identify a transplantable graft with machine perfusion was $28,099 USD. CONCLUSIONS: Normothermic machine perfusion of discarded livers could identify a significant number of transplantable grafts, significantly improving access to liver transplantation.
BACKGROUND: Over 700 donor livers are discarded annually in the United States due to high risk of poor graft function. The objective of this study was to determine the impact of using normothermic machine perfusion to identify transplantable livers among those currently discarded. STUDY DESIGN: A series of 21 discarded human livers underwent viability assessment during normothermic machine perfusion. Cross-sectional analysis of the Scientific Registry of Transplant Recipients database and cost analysis was performed to extrapolate the case series to national experience. RESULTS: 21 discarded human livers were included in the perfusion cohort. 11 of 20 (55%) eligible grafts met viability criteria for transplantation. Grafts in the perfusion cohort had a similar donor risk index compared with discarded grafts (n = 1402) outside of New England in 2017 and 2018 (median [IQR]: 2.0 [1.5, 2.4] vs. 2.0 [1.7, 2.3], P = .40). 705 (IQR 677-741) livers were discarded annually in the United States since 2005, translating to the potential for 398 additional transplants nationally. The median cost to identify a transplantable graft with machine perfusion was $28,099 USD. CONCLUSIONS: Normothermic machine perfusion of discarded livers could identify a significant number of transplantable grafts, significantly improving access to liver transplantation.
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Authors: Katherine Xu; Siavash Raigani; Angela Shih; Sofia G Baptista; Ivy Rosales; Nicola M Parry; Stuti G Shroff; Joseph Misdraji; Korkut Uygun; Heidi Yeh; Katherine Fairchild; Leigh Anne Dageforde Journal: Transplant Direct Date: 2022-08-04
Authors: Siavash Raigani; John Santiago; Anders Ohman; Megan Heaney; Sofia Baptista; Taylor M Coe; Reinier J de Vries; Ivy Rosales; Angela Shih; James F Markmann; Philip Gruppuso; Korkut Uygun; Jennifer Sanders; Heidi Yeh Journal: Front Immunol Date: 2022-07-26 Impact factor: 8.786
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