* Human livers kept alive and functioning on new machine
* Livers then successfully transplanted into two patients
* Device could up to double number of livers for transplant
* Technology now in patient trials at London hospital
By Kate Kelland, Health and Science Correspondent
LONDON, March 15 (Reuters) – A donated human liver has been
kept alive, warm and functioning outside a human being on a
newly-developed machine and then successfully transplanted into
patients in a medical world first.
A British team of doctors, engineers and surgeons announcing
the achievement on Friday said it could be common practice in
hospitals across the developed world within a few years, up to
doubling the number of livers available for transplant.
So far the procedure has been performed on two patients on
Britain’s liver transplant waiting list and both are making
excellent recoveries, the medical team told a news conference.
“It was astounding to see an initially cold, grey liver
flushing with colour once hooked up to our machine and
performing as it would within the body,” said Constantin
Coussios, a professor of biomedical engineering at Oxford
University and one of the machine’s co-inventors.
“What was even more amazing was to see the same liver
transplanted into a patient who is now walking around.”
Currently livers destined for transplant are kept “on ice”
in a process which cools them to slow down their metabolism and
does not keep them functioning as they would inside a body.
This system has worked for several decades, but can also
often lead to livers becoming damaged and rendered unfit for use
in patients who need them.
Surgeons say keeping livers “on ice” beyond 14 hours starts
becoming risky, although they can last up to 20 hours.
Hepatitis infection, alcohol abuse and drug-induced
cholestasis – a blockage in the flow of bile from the liver –
can all cause liver failure. Some patients with liver cancer can
also benefit from a transplant.
Around 13,000 liver transplants are carried out each year in
Europe and the United States, but there is a combined waiting
list of around 30,000 patients who need a new liver.
Experts say up to a quarter of these patients die while they
are waiting. At the same time, more than 2,000 livers are
discarded every year because they are either damaged by oxygen
deprivation or do not survive the cold preservation process.
The new technology, developed by Coussios together with
Peter Friend, director of the Oxford Transplant Centre,
preserves the liver at body temperature and “perfuses” it –
supplying it with oxygenated red blood cells to keep it alive.
“This device is the very first completely automated liver
perfusion device of its kind,” Coussios said. “These first
clinical cases confirm that we can support human livers outside
the body, keep them alive and functioning on our machine and
then, hours later, successfully transplant them into a patient.”
“I FEEL SO ALIVE”
The device can keep a liver functioning normally – just as
if in a person, with blood circulating through its capillaries
and bile being produced – outside the body for 24 hours or more.
The results from the first two transplants using the new
technology, carried out at King’s College Hospital (KCH) in
London last month, suggest the device could be useful for all
patients needing liver transplants, Field told reporters.
The new device could also mean livers which would otherwise
be discarded as unfit for transplantation could be preserved and
made viable – potentially as much as doubling the number of
organs available for transplant, he said.
“If we can introduce technology like this into everyday
practice, it could be a real, bona fide game changer for
transplantation as we know it,” said Nigel Heaton, director of
transplant surgery at KCH and part of the team that carried out
the first two transplants using the device.
Coussios and Friend have been researching the technology for
the device since 1994 and are developing it through an Oxford
University spin-off company called OrganOx.
The first person to receive a transplanted liver kept alive
on the OrganOx system was 62-year-old Briton Ian Christie. He is
still recovering from the surgery but said in a statement he was
getting better day by day. “I just feel so alive,” he said.
Christie was told last year he had cirrhosis of the liver
and had only 12 to 18 months to live unless he got a transplant.
“I was placed on the waiting list but…I was very worried.”
Having been through the surgery, he said: “I feel better
than I’ve felt for 10 to 15 years, even allowing for the pain
and wound that’s got to heal.”
The team now plans to run a pilot trial with 20 more liver
transplant patients at KCH. Coussios said successful results of
that trial would allow OrganOx to apply for marketing authority,
meaning the device could be on the market by as early as 2014.
(Reporting by Kate Kelland; Editing by Peter Graff)
