This is quite interesting, Canuck. I’m continually amazed by the advances they are making in organ transplantation. The fact they can keep an organ alive and viable in such a manner, while making it healthier pre transplant, is incredible. Now I‘m wondering, is there something they can do (like this) to reduce this spare tire around my waist? Just plug me in, warm me up and de-fat me. Ya, that’s the ticket! 

Loosely on the same topic Boxers brought up here, about getting lots of "duty" out of a donated liver .... here's another article where they might get more bang for the buck by how they handle donor livers and by potentially "de-fatting" livers! Man, what good ideas next! I am all for freeing up any potentially good liver for donation!

News · November 13, 2018

AASLD 2018: Fat in Steatotic Donor Livers Can Be Reduced With Machine Perfusion

These livers are then rendered suitable for transplantation.

PracticeUpdate Editorial Team 

November 13, 2018 - San Francisco, California - Normothermic machine perfusion can be used to preserve steatotic livers, leading to altered lipid structure and metabolism that may result in more successful transplantation of these organs.

This conclusion, based on results of a placebo-controlled comparative study, was presented at the 2018 Liver Meeting® of the American Association for the Study of Liver Diseases, from November 9 -13.

Carlo Ceresa, MBChB, MRCS, noted that the amount of de novo lipogenesis fatty acids were significantly decreased in the liver over 48 hours following alteration of glucose and insulin concentrations, which led to decreased liver fat. Furthermore, the addition of l-carnitine led to increased mitochondrial fatty acid oxidation, where the liver uses fatty acids for energy production.

Dr. Ceresa and colleagues set out to evaluate normothermic machine perfusion and de-fatting adjuncts in human steatotic livers, as well as how grafts could be enhanced to enable successful transplantation.

Because many patients die waiting for a liver transplant due to the shortage of suitable donor livers, discovering methods that can facilitate safe and reliable transplantation of higher-risk livers will be beneficial for maximizing the donor pool. Fatty livers contribute to the largest portion of discarded organs; therefore, salvaging these livers for transplantation would be very beneficial.

The researchers selected 16 human livers that had been declined for transplantation due to steatosis. The livers were perfused on a normothermic, oxygenated, blood-based circuit for 48 h.

The livers were divided into three groups: six were perfused with normothermic machine perfusion alone, five were perfused with normothermic machine perfusion + lipid apheresis filtration, and five were perfused with normothermic machine perfusion, lipid apheresis filtration, and defatting agents.

Donor demographics and preperfusion total macrovesicular steatosis levels were similar between all three groups of livers. All livers demonstrated similar patterns of metabolic and synthetic function, ensuring valid comparisons of fat metabolism based on these interventions.

Adding a lipid apheresis filter to normothermic machine perfusion resulted in a significant reduction of circulating triglycerides by 48 h vs normothermic machine perfusion alone.

This reduction was also seen when livers perfused with a lipid apheresis filter and defatting agents were compared with those perfused with normothermic machine perfusion alone.

Livers filtered by lipid apheresis also demonstrated a significant reduction in perfusate total cholesterol vs those perfused with normothermic machine perfusion alone.

In the livers to which defatting agents were added, an increase in median fatty acid oxidation vs the other two groups was observed. This group of livers also showed an average reduction in tissue triglyceride level, a significant finding compared with the other two groups.

The findings demonstrated that normothermic machine preservation of steatotic livers for 48 h altered lipid structure and metabolism. This alteration may result in more successful transplantation of these organs.

Steatotic livers may lead to poor outcomes after transplant and, as a result, many of these organs are discarded. The global obesity epidemic will likely increase the proportion of steatotic livers in the donor pool.

A potential method to salvage these livers for transplantation is normothermic machine perfusion, which maintains the liver in a fully functioning state ex situ, providing oxygen and nutrition at 98.6°F (37°C). This allows functional liver assessment and provides the potential for therapeutic interventions that may optimize the graft.

Dr. Ceresa noted that the next trial will be designed to determine whether clinical outcomes are improved following ex situ interventions on fatty livers. It will also be important to understand whether all steatotic livers can be salvaged. Gene expression analysis may be used to identify additional drug targets for exploration in the process of defatting steatotic livers.

I merged both Donor Organ threads. This way we’re not bouncing back and forth between the two and missing posts. 

I noticed a message Canuck left in the Healio updates thread and thought I would share a little bit more information I found on the topic. The UT Southwestern Medical Center is at the forefront of transplantation and this is another example of their commitment.

Warming Up Technology

Hey, sorry boxers, for some reason i never really read this post you made, i had read the prior one of the same/similar title (maybe that's why i overlooked this one thinking it was the same one?) ... regardless, i was glad for your new news here.

So, some good news, some not so good and some stuff middling. In the not so good categories are the fighting with the wound stuff, which is very slow to completely resolve for you (but I am sure it will eventually!), and the hernias thing (you have had unfortunate prior experience with that haven't you) maybe the prior acities and hernia hx, prior pressures/procedures, still can have an influence and affect on the strengths of your abdominal walls now? Perhaps had some pre-built-in weaknesses of some sorts? Even with out prior abd. wall stuff, these are radical wall/sheath (and everything) incisions they make to open you up to get access to everything for the transplant eh?

And of course, in the not so good to middling news, there is that ongoing balancing act of having to take all these imm. sup meds you have to be on, anti-fungals/anti-virals and such - then having to battle other opportunistic infections or overgrowth from time to time. I am glad you get the benefit of seeing both kinds of docs (your family doc AND the liver doc) one should help see what the other may not. I hope your girly flora culture comes back into line, quick.

Hey, (way back) you had a lung thing that you put yourself on antibiotics for (antibiotics that you already had at home) - just curious, how long did you keep take those antibiotics and how long did it take for the lung thing to resolve?? Did any doc help to keep you on the antibiotics, or, did they make you stop taking the antibiotics?? Just wondering how that one all turned out and what they thought about you being on those antibiotics?

Great news about your LFT's, and that lovely low stable tac level! What have your ALT's and AST's, etc been running at? How much weight have you managed to gain?

I am glad you asked and found out about your donor, I can imagine it must be/feel huge to take in. You explained it well, going from "physical" to personal, shocking enough thus far just the physical!, no doubt you will do some serious wondering and pondering about him, his life, his family and their lives, only natural. Just as you have such wishes for comfort and condolence for his family, you can trust that they are wishing ONLY the greatest comfort and good life for you. You will be their comfort. C.   

Thank you so much for the update, boxers. I didnt realize you had had a transplant! Yowza that is huge! Congrats! Sending healing vibes your way along with prayers and well wishes. 

Dang, I was at the doc. yesterday and forgot to ask about reusing the donor organ, will have to write it down . I did find out yesterday, after asking if I was allowed to know the age and sex of my donor, that it was a 17 year old male, I don't know why but I was stunned. Very emotional, at first you have this physical attachment and now it is much more personal with an emotional attachment. Sadly most 17 yr. olds die from trauma (car, diving, gunshot etc.), suicide or drug OD. I don't think they would give you a liver from a diseased person unless maybe congenital heart disease. Regardless, I am sure there is a grieving family out there. I will wait a year to make sure they have some grieving time and I am OK before I write them a letter. Not so sure that I should send it around his anniversary date. On the bright side my labs were fabulous, Liver enzymes almost normal and Tac. level is 5.2 which they want to keep around 5. Unfortunately, (thanks to my sweet primary doctor listening to me) I found out I have two hernias, one left lower abd. and one (large) right side at the end of the incision...guess I will have to find me a truss or corset and suck it up. No more surgery unless I have to. Liver docs did UA 2 weeks ago but came back clear, told primary about it and she did a girly exam with a culture...it was obvious I had an infection. Told liver doc. so they stopped my antiviral and antifungal, flora apparently messed up. I do eat a fruit smoothie with yogurt everyday but.....My wounds are about 80% closed, actually two will probably be closed by next week and two more to go. Well that's my story, thanks for listening. I sincerely hope everyone's treatments are going well and you will be free of that creature soon.

Hey, it works for me, too!  

That’s an amazing story! It’s the first time I have heard of a retransplanted organ. Now that’s getting some real mileage  

That is a good question! I kind of doubt they would transplant it again, but hey, if it was functioning perfectly and God forbid you had an accident and someone needed it, then I suppose anything is possible. I’m thinking that the useful life of our organs is probably 60ish years for transplantation, maybe more depending on the health of the donor.

Doubtful. Intriguing question though. Very thought provoking. What is the useful life of a liver? 100 years? Depending on circumstances, 200 years?

This may be a silly question but if you donate your organ (liver) will they take a donar organ and use it twice?