Premium
Viability testing of discarded livers with normothermic machine perfusion: Alleviating the organ shortage outweighs the cost
Author(s) -
Raigani Siavash,
De Vries Reinier J.,
Carroll Cailah,
Chen YaWen,
Chang David C.,
Shroff Stuti G.,
Uygun Korkut,
Yeh Heidi
Publication year - 2020
Publication title -
clinical transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.918
H-Index - 76
eISSN - 1399-0012
pISSN - 0902-0063
DOI - 10.1111/ctr.14069
Subject(s) - machine perfusion , medicine , economic shortage , perfusion , transplantation , cohort , liver transplantation , cold storage , surgery , linguistics , philosophy , government (linguistics) , biology , horticulture
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.