New way of keeping donor livers healthy.

New way of keeping donor livers healthy

The first large-scale clinical trials of an experimental organ-preservation fluid kept human livers alive as long as 24 hours -- a finding that may "revolutionize" the field of liver transplantation, researchers say. The new method may increase the number of livers available for transplantation and allow surgeons to schedule surgery, rather than performing emergency procedures on livers that last just 10 hours in conventional solution.

Transplants are the last hope for patients with end-stage liver disease, but a key barrier to transplantation has been the shortage of usable livers. The 10-hour time limit required transplant teams to get donor livers from the same geographic region, and even then they had to rush the organs back to the hospital. The experimental fluid, developed in 1987 by University of Wisconsin-Madison researchers (SN: 7/4/87, p.5), keeps livers alive longer, allowing transplant teams to fly across the United States and even overseas for a suitable liver.

Satoru Todo, Thomas E. Starzl and their colleagues at the University of Pittsburgh looked at 185 livers treated with the experimental solution and 180 prepared with Collins fluid, the traditional organ-preservation fluid. They found that 44 percent of livers in the experimental group lasted longer than 9.5 hours and some were stored as long as 24 hours. In contrast, livers preserved with Collins fluid showed deterioration after 5 hours, and all were unusable after 9.5 hours, the researchers report in the Feb. 3 JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION.

The Pittsburgh team also compared 151 first-time liver-transplant patients who received livers preserved with the experimental fluid with 144 controls who got livers prepared conventionally. Liver-function tests performed a week after surgery showed abnormalities in controls who received a liver stored longer than 5 hours. There was no correlation between test results and storage time in the experimental group. Furthermore, experimental patients proved less likely to require a second transplant.

The experimental preservation fluid was developed by University of Wisconsin researchers Folkert O. Belzer and James H. Southard. Nobody knows exactly how the solution works, but Southard says it seems to prevent liver cells from swelling when they are chilled, a condition that leads to organ death. The solution, now being tested by transplant centers nationwide, may not be necessary for all types of organs, he adds. Kidneys, for example, can be kept for several days using conventional preservation methods.