Physicians in the University of Alabama at Birmingham Department of Surgery have transplanted Alabama’s first patient with a cadaver liver that was recovered from the donor and “kept alive” and preserved at body temperature instead of the standard cold solution — a technique that enables the patient to receive a liver that surgeons can watch produce bile before it is transplanted.

The transplant was performed recently by UAB Medicine surgeons on Lana Wiggins, a Valley, Alabama, resident, as part of a clinical trial using a normothermic machine perfusion technique developed by OrganOx. Surgeons place the cadaver liver in the normothermic machine, which then pumps the organ with warm, oxygenated blood and nutrition at or just below body temperature for up to 24 hours before transplant. Devin Eckhoff, MD, director of UAB’s Division of Transplantation, says the technique has shown great success in European studies and appears to provide a significant improvement in the quality of the transplanted cadaver organ.

“These normothermic machines enable us to preserve the liver under near perfect physiological conditions – as opposed to the usual hypothermic conditions in which the organ is typically transplanted. With the normothermic preservation, the liver maintains all aspects of graft function throughout the preservation process; it allows for pre–transplant assessment of organ function and thereby viability to predict suitability for implantation and the delivery of potential agents such as stem cells to further improve the tissue damage caused when blood supply returns to the tissue after a lack of oxygen,” Eckhoff said.

UAB’s School of Medicine and UAB Hospital have joined 14 other transplant centers in the United States in this study. Research efforts like this clinical trial have focused on overcoming the limitations of cold storage, which is the current universal standard for organ preservation, with a move toward normothermic machine perfusion.

Although limited in terms of the duration of preservation, cold storage has the major advantages of simplicity, portability and affordability. However, with increased use of marginal organs in recent years because of the dearth of livers available, the limitations of static cold storage are a major factor influencing patient and graft survival rates.

The machine that houses the liver to preserve it prior to transplant is the first completely automated liver perfusion device of its kind. It works similar to a greenhouse, and is constructed from basic components that make up conventional cardiopulmonary bypass, including basic roller pumps, oxygenators and heat exchangers.

“This machine can really help in a number of ways,” said Stephen Gray, MD, liver transplant surgeon and director of UAB’s Abdominal Transplant Fellowship. “The fact that the machine can perfuse the organ with oxygenated red blood cells at normal body temperature – just as it would be inside the body – and that we can observe it making bile before transplant is just an extraordinary feat, and a significant benefit to us as surgeons and our patients. With these normothermic machine–perfused livers, we can assess whether it is going to work before we transplant it into the patient, whereas we typically do not know if the liver will work until the transplant takes place.”

This kind of advancement could mean livers can eventually be shipped from coast to coast in the United States, an impossibility for cold–stored livers. If that is the case, geography would not be as much of a hurdle to transplant those most in need. It also means surgeons would not have to operate overnight if a liver can be kept viable for up to 24 hours.