Technical feasibility of liver transplantation without cold storage

Abstract

The success of liver transplantation (LT) is accompanied by an increased need for organs. The wider use of older donors and marginal organs with risk factors such as steatosis has lead to a new interest to improve the outcome with marginal organs. We herewith report a novel technique for LT with in situ preparation and immediate warm-ischemia liver transplantation (WI-LT). The aim of our study was to demonstrate the technical feasibility and report the transplant course. Six patients underwent WI-LT at our institution. Hepatectomies during procurement and LT were both performed in parallel by different surgical teams. Technical factors and postoperative allograft function were analyzed. All six WI-LTs were performed without intraoperative complications with a mean warm-ischemia time (WIT) of 29.0min. No patient developed primary non-function or required retransplantation. Mean alanine aminotransferase (194.0 ± 170.4U/l) and aspartate aminotransferase (316.3 ± 222.1U/l) values on the first postoperative day were low, indicating a low ischemia/reperfusion injury and an excellent liver function. These results demonstrate that WI-LT is a safe and technically feasible approach for LT with possibly reduced IRI and an excellent postoperative allograft quality. WI-LT may therefore be considered in individual patients especially with extended criteria donors to eventually improve postoperative allograft quality.