ArticleAnnals of surgery2023
Defatting of Human Livers During Long-Term e x situ Normothermic Perfusion: Novel Strategy to Rescue Discarded Organs for Transplantation.
Article in Annals of surgery, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers.
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Who cites it
18 citing papers in PubMed, 33 citations in OpenAlex.
- Advancing Organ Preservation and Perfusion: Introducing the International Society of Organ Preservation and Perfusion Therapy (ISOPPT).Artificial organs · 2026Article
- From Preservation to Repair: A Systematic Review of Therapeutic Organ Rehabilitation During Normothermic Ex Vivo Machine Perfusion.Transplantation direct · 2026Review
- Hemodiafiltration improves performance of 24 hour ex situ normothermic liver machine perfusion.JHEP reports : innovation in hepatology · 2026Article
- Steatotic liver disease and liver transplantation: Candidate selection and post-transplant management.JHEP reports : innovation in hepatology · 2026Review
- Transplantation of older DCD livers in the machine perfusion era: a U.S. cohort study.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Revealing the potential of non-transplanted donor organs: a comparative analysis in the Eurotransplant region.Transplant international : official journal of the European Society for Organ Transplantation · 2026Article
- Time as a Therapeutic Ally: The Promise of Long-Term Solid Organ and Tissue Perfusion.Transplant international : official journal of the European Society for Organ Transplantation · 2026Review
- Back-to-base normothermic perfusion for livers with severe steatosis: a call for caution.Clinical transplantation and research · 2025Article
- [Research progresses in ex vivo liver perfusion technology].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Review
- [Advances in liver transplantation technology].Zhonghua gan zang bing za zhi = Zhonghua ganzangbing zazhi = Chinese journal of hepatology · 2025Review
- Liver Machine Perfusion: Past, Present and Future Directions.Biomedicines · 2025Review
- Beyond preservation: future machine perfusion for liver assessment and repair.Nature reviews. Gastroenterology & hepatology · 2025Review
- Therapeutic hyperthermia promotes lipid export and HSP70/90 during machine perfusion of human livers.Physiological reports · 2025Article
- Long-term machine perfusion of human split livers: a new model for regenerative and translational research.Nature communications · 2024Review
- Long-term normothermic machine perfusion of fatty livers: towards transplanting untransplantable livers?Hepatobiliary surgery and nutrition · 2024Article
- Steatotic Donor Transplant Livers: Preservation Strategies to Mitigate against Ischaemia-Reperfusion Injury.International journal of molecular sciences · 2024Review
- Xenoperfusion-The Transformative Role of Machine Perfusion in Xenotransplantation.XenotransplantationReview
- Current Techniques and Indications for Machine Perfusion and Regional Perfusion in Deceased Donor Liver Transplantation.Journal of clinical and experimental hepatologyReview
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Authors and funding
20 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo develop a protocol for the defatting of steatotic liver grafts during long-term ex situ normothermic machine perfusion.
backgroundDespite the alarming increase in donor organ shortage, the highly prevalent fatty liver grafts are often discarded due to the risk of primary nonfunction. Effective strategies preventing such outcomes are currently lacking. An exciting new avenue is the introduction of ex situ normothermic machine perfusion (NMP), enabling a liver to remain fully functional for up to 2 weeks and providing a unique window of opportunity for defatting before transplantation.
methodsOver a 5-year period, 23 discarded liver grafts and 28 partial livers from our resection program were tested during ex situ normothermic machine perfusion. The steatosis degree was determined on serial biopsies by expert pathologists, and triglyceride contents were measured simultaneously.
resultsOf 51 liver grafts, 20 were steatotic, with up to 85% macrovesicular steatosis, and were perfused for up to 12 days. Ten livers displayed marked (5 of which almost complete) loss of fat, while the other 10 did not respond to long-term perfusion. Successful defatting was related to prolonged perfusion, automated glucose control, circadian nutrition, and L-carnitine/fenofibrate supplementation. Pseudopeliotic steatosis and the associated activation of Kupffer/stellate cells were unexpected processes that might contribute to defatting. Synthetic and metabolic functions remained preserved for most grafts until perfusion ended.
conclusionEx situ long-term perfusion effectively reduces steatosis while preserving organ viability and may in the future allow transplantation of primarily unusable high-risk grafts, significantly increasing the number of organs available for transplantation.
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