The Operating Theatre Journal November 2020

More documents

Recommendations

Info

A new technique could make more liversavailable for transplant2020doi: 10.3310/alert_41703Demand for liver transplants is so high that many people on the waitinglist die before they can receive a transplant. But surgeons are rejectingincreasing numbers of donated livers because they are not satisfiedwith the quality. New research could address this problem and makemore livers available for transplant.Current practice is for most organs to be stored in ice after beingremoved from donor patients. But organs can deteriorate in ice or bejudged to be unsuitable for transplant.Researchers studied a technique called Normothermic MachinePerfusion (NMP). It keeps blood flowing through the liver while it isoutside the body. The liver is preserved in a near real-life conditionwhile it is assessed for transplant.The new trial, called VITTAL, showed that many livers which had beenrejected by surgeons could be transplanted successfully into patients.This is a step forward in making more livers available for transplantation.What’s the issue?In recent years, more livers are becoming available for transplantation,but they are increasingly from older, more obese, donors. That meansthe livers are of lower quality and many are rejected by surgeons.In 2016-17, 240 patients (19%) waiting for liver transplants in the UKeither died or were removed from the waiting list.Liver donations increased markedly between 2008 and 2018. At thesame time, the proportion of livers that were rejected almost doubled.Surgeons are concerned about offering lower quality livers to sickerpatients. But these decisions are often based on opinion, not hard fact.The quality of livers stored in ice can deteriorate between removalfrom a donor and transplant into the recipient. The NMP techniquemimics real life. The donor liver receives oxygenated blood and othernutrients while outside the body. Its condition is preserved and mayeven improve.The VITTAL trial looked at livers classed as unsuitable for transplantationby surgeons. It assessed whether the NMP technique could revive liversso they could be offered to patients.What’s new?The VITTAL trial was the first to investigate and evaluate NMP for donorlivers that were initially discarded. It found that the technique couldsalvage some of the livers that are currently discarded.The study has already made a difference. The research team is nowusing NMP as a clinical tool to assess livers. They are now transplantingsome livers that they would previously have thrown away. This meansmore livers are available to patients. Other UK liver transplant centresare considering a similar move.What’s next?During the VITTAL study, livers were only offered to the least sickpatients who were most likely to respond well. Another study isunderway to assess the use of these “rescued” livers on other patients.The study will include patients on the waiting list who are moreunwell, or who are waiting for a second transplant and have limitedlife expectancy.Further work is needed to look for markers in blood and perfusionsamples which could help predict the outcome of liver transplants usingNMP.All seven UK liver transplant centres have the technology to usethis technique. The researchers hope that the trial will help buildthe experience and confidence to use livers previously regarded asunsuitable for transplant.You may be interested to readThe full paper: Mirza DF, and others. Transplantation of discardedlivers following viability testing with normothermic machine perfusion.Nature Communications, 2020;11:2939Nasralla D, and others. A randomized trial of normothermic preservationin liver transplantation. Nature, 2018;557;50–56Porte R, and others. Pretransplant sequential hypo‐ and normothermicmachine perfusion of suboptimal livers donated after circulatory deathusing a hemoglobin‐based oxygen carrier perfusion solution. Am JTransplant, 2019;19(4);1202–1211.Clavien P-A, and others. Recommendations for liver transplantationfor hepatocellular carcinoma: an international consensus conferencereport. Lancet Oncol, 2012; 13(1); e11–e22.FundingThis study was funded by the Wellcome Trust and Cancer Research UK.It was supported by the NIHR Birmingham Biomedical Research Centreat the University Hospitals Birmingham NHS Foundation Trust and theUniversity of Birmingham.Source: NIHRBetween November 2016 and February 2018, livers dismissed by surgeonsas unusable were assessed. They were transplanted into patients whohad been counselled about the high-risk nature of this trial.During the trial, 185 livers were discarded by surgeons across the UKand offered to the study. Of these, 31 were re-examined and 22 weretransplanted into patients.The study found that:• all patients were alive when followed up one year or more later,though some had developed complications• by day 542, four patients needed another liver transplant for problemsrelated to the bile duct.Why is this important?Keeping livers in a near real-life situation, rather than in ice, may givea better indication of whether they will be successfully transplanted.If they are working well on NMP, they may be more likely to work wellin a patient.Using some of the livers which are currently discarded would addsignificantly to the number of livers suitable for transplant in the UK.This would help reduce the numbers of patients dying while on thewaiting list.Interventional Approaches for Cancer RelatedPain & Acute Pain and Persistent Post SurgicalPain Two-day Virtual Conference10th – 11th December 2020Cost:Day 1 & Day 2 Sessions £120 per delegate1 Session only: £60 per delegateFor further information and to book your place please visit:www.royalmarsden.nhs.uk/studydaysGet in touch:Conferenceteam@rmh.nhs.uk or Telephone: 020 7808 2921The Royal Marsden Education and Conference CentreStewart’s Grove, London, SW3 6JJ18 THE OPERATING THEATRE JOURNAL www.otjonline.com
Hospital InnovationsStay Safe PPE Rangewww.HIPPE.co.ukWe would like to introduce you to our StaySafe PPE Range. We understand theimportance of providing the highest qualitymedical grade PPE to keep you safe andprotected during this Covid-19 pandemic.Stay Safe PPE Non-woven fluid repellent Single-use Safety Gown; Item code: HSG2 High quality and comfort reusable face shield; Item code: FSR1 Type IIR (fluid repellent) face masks; Item code: HIFM1R Type II everyday face masks; Item code: HIFM1 Medical grade Apron; Item code: HIFA1 KN95 respirators; Item code: HIFM2For further information contact us using thedetails below:T: 01443 719 555E: info@hospitalinnovations.co.ukHospital Innovations LimitedConcept HouseTalbot Green Business ParkPontyclunCF72 9FGwww.HIPPE.co.uk
Page 1 and 2: £2.00November 2020 Issue No. 362 I
Page 3 and 4: November 2020 Issue No. 362 ISSN 17
Page 5 and 6: Introducing the newCS Spine Frame+
Page 7 and 8: Covid-19 What have we learned about
Page 9 and 10: Trying to catch up withday-to-day d
Page 11 and 12: Mölnlycke Procedure TraysSave 40%
Page 13 and 14: http://bit.ly/OTJtheatreSummitGetin
Page 15 and 16: Lithotomy Stirrups from Melyd Surgi
Page 17: Vygon signs exclusive agreement wit
Page 21 and 22: nightentify’s newwill aationsbrin
Page 23 and 24: Discovering the many more pages ava
Page 25 and 26: Their portfolio comprises a range o
Page 27 and 28: MMI SpA Launches Breakthrough Techn
Page 29 and 30: Reduced manual handlingfor transpor

The Operating Theatre Journal November 2020

Create successful ePaper yourself

Delete template?

Save as template?