How do you ensure that patients have a good life after a liver transplant, even if the liver they received is not in top shape? RUG transplant coordinator Rianne van Rijn was determined to find out. ‘The moment the liver is removed from the donor body, the oxygen is cut off. During that time, the liver also develops an energy deficit.’
The liver should start working as soon as it is transplanted into its new owner’s body. But that energy deficit remains. ‘That means the donor liver starts by having to make up for that lost energy’, she explains.
Machine perfusion
For her PhD research, Van Rijn looked at procedures that could anticipate the liver’s deficit. Machine perfusion plays an important role in this. ‘It allows us to jump start the liver, so to speak, which means it can get to work the moment it’s transplanted.’
During perfusion, the liver’s blood vessels – the artery and the portal vein – are hooked up to tubes, which then flush the liver with a cold liquid containing oxygen and various nutrients. ‘It allows us to elevate the liver’s oxygen levels to normal’, says Van Rijn. ‘This way, we can prevent some of the harmful processes that started when the liver was removed’, the future surgeon explains.
Promising
Her research only used ten patients, but the results are promising. ‘There were no detectable harmful effects, and some of the advantageous effects were even significant: an increase in energy levels, better blood levels post transplant, and a bile duct that is more protected from damage’, Van Rijn explains.
Unfortunately, perfusion does not (yet) mean that livers can be stored outside the body for longer periods. ‘The moment livers enter the UMCG, we hook them up to a perfusion machine. At the same time, a different team starts operating on the receiver. We do everything we can to not lose time.’
But without the perfusion, livers end up leaking energy in a cooler while the receiver is prepared for the transplant.
Unused livers
Her PhD research completed, Van Rijn is now working on an international study of 160 patients. She wants to see if receiving a liver that has undergone perfusion makes a difference in the complications patients experience after transplant. The study only focuses on donor livers that have been transplanted, but the future surgeon would like to expand her research.
There are approximately 250 organ donors each year in the Netherlands, but only 75 livers are transplanted. ‘That means that seventy percent of the available livers go unused. That’s because of risk factors such as age, fatty degeneration, and the donor’s consumption of alcohol or medication. You name it. But there’s still a lot we can use there – I’m sure there are a few livers that are still good enough to be transplanted.’