The following is a summary of “Defatting of Human Livers During Long-Term ex situ Normothermic Perfusion: Novel Strategy to Rescue Discarded Organs for Transplantation,” published in the November 2023 issue of Surgery by Silva, et al.
For a study, researchers sought to devise a plan for losing fat from steatotic liver grafts while under long-term ex-situ normothermic machine treatment. Even though the number of people who need organ donors is alarmingly high, fatty liver grafts are often thrown away because they might not work properly. Effective methods must be included to stop these kinds of things from happening currently. Ex situ normothermic machine perfusion (NMP) is an exciting new way to do things that lets a liver stay fully functional for up to two weeks and gives doctors a unique chance to lose fat before transplanting.
Over 5 years, 23 liver patches that were thrown away and 28 partial livers from their surgery program were put through ex-situ normothermic machine perfusion tests. Expert doctors looked at a series of tests to determine the level of steatosis and measure the amount of triglycerides simultaneously. Out of the 51 tested liver grafts, 20 had steatosis (up to 85% macrovesicular steatosis) and were pumped with blood for up to 12 days. Ten of the livers lost a lot of fat, and five lost it almost completely.
The other ten livers did not respond to long-term oxygenation. Long-term irrigation, automatic glucose control, a diurnal diet, and L-carnitine/fenofibrate supplements were all linked to successful fat loss. Unexpected processes that might help defatting were pseudoplastic steatosis and the activity of Kupffer/stellate cells that went along with it. Most grafts kept their metabolic and synthetic activities until the circulation stopped. Ex situ long-term oxygenation successfully lowers steatosis while maintaining organ survival. In the future, it is possible to transfer mostly useless high-risk grafts, which greatly increases the number of organs that can be transplanted.
