The First Series of Normothermic Machine Perfusion in India - The Way Ahead

Abstract

Background: Normothermic machine perfusion (NMP) has revolutionized the field of liver transplant and is rapidly gaining popularity for utilising suboptimal livers, which were refused previously.Marginal liver with static cold storage (SCS) is associated with increased risk of primary non-function & early allograft dysfunction. NMP enables preservation of liver in "near-physiological" conditions.NMP promotes better utilisation of the resources to meet the increasing demand for organs. Case Series: We have used NMP (OrganOx) for three patients as summarized: Case 1 - Donor was a 65yr old elderly male, alcoholic since 35 yrs. Case 2 - The donor liver biopsy revealed 40-50% steatosis. Case 3 - The arrival of recipient was delayed by 6 hours. Perfusate fluid– PRBCs, Gelofusin, NaHCO3,Insulin,Bilesalts, Prostacyclins, Antibiotics and Nutrients. These donor livers were given a trial of NMP at 37°C. During NMP, perfusion fluid samples were assessed for arterial blood gases (pH, pO2, pCO2, HCO3), lactates, glucose,calcium and potassium every 30 minutes. Bile production was measured to assess liver function.As the measured indices were satisfactory, we have used the harvested organs for transplant. All the recipients fared well post-transplant with normothermic machine perfused organs. Conclusion: NMP addresses the dilemma of using extended criteria donor grafts. NMP optimises the donor liver utilization by improved preservation techniques, graft reconditioning and viability assessment before transplantation. Thus, our experience of NMP is promising and shows huge potential for future research.