A breath of fresh air for organ transplantation
Better outcomes, even with older and less-promising donor organs: new methods trialled by an EU-funded project have generated compelling results, widening the scope to transplant kidneys and livers that might otherwise not have been considered. Patients and healthcare systems both stand to benefit.
© Organ Assist
The EU-funded COPE project trialled innovative techniques to make more donated organs transplantable, highlighting the potential of two of the proposed innovations. COPE also assembled a vast biobank of material that is facilitating further research. It involved a large number of specialised European transplant centres as well as several industrial partners. One of the key issues in transplantation is the shortage of donor organs, says project coordinator Rutger Ploeg of the University of Oxfords Nuffield Department of Surgical Sciences in the UK.
We have to accept more organs to avoid waiting lists getting even longer, he explains. These new techniques allow us to assess donated livers and kidneys more effectively and to achieve better results when we transplant them.
Both innovations involve machine perfusion, the use of devices that pump a liquid known as perfusate through donated organs before transplantation. For higher-risk kidneys, for example from older donors, this approach was already known to offer better results than the cold storage techniques by which organs are transported in the iconic ice boxes, Ploeg notes.
The benefits of keeping livers warm ...
COPE explored the potential for livers, with one crucial difference: whereas machine perfusion of kidneys involves cold liquid, the device used in the projects liver trial operates at body temperature.
This method greatly improved organ function immediately after the operation, says Ploeg. It also widens the typical 10-hour window for a potentially successful liver transplant, giving surgeons more time to assess organs and select the most suitable recipients. Many a liver that might otherwise have been discarded does actually start to function in the machine, Ploeg adds.
... and kidneys oxygenated
However, using warm perfusate adds complexity, and it may not always be necessary. COPE also trialled an innovative approach using oxygenated cold machine perfusion for kidneys. The results indicated that enriching the perfusate with oxygen boosts kidney function, reduces the risk of graft failure and halves the risk of rejection.
A third COPE trial assessed the added value of a brief period of oxygenated machine perfusion following the initial cold storage of kidneys. The idea is to still use ice boxes rather than the costlier perfusion machines for transport, but to recondition the organs upon arrival, Ploeg explains. The COPE trial was the first to evaluate the combination of both techniques, although it indicated no benefit.
The projects findings have already changed recommended practice in several countries. Without the involvement of partners in different countries, they might have remained out of reach, Ploeg emphasises: In the European context, collaboration between transplant centres is crucial. For us in the medical community, the EU is the perfect mechanism to allow clinical research to happen across borders and benefit patients.