Combined liver and lung transplantation with extended normothermic liver preservation using TransmedicsOrgan Care System (OCS)™ liver: A single center experience
Konel J, Shamaa MT, Shamaa O, Elsabbagh A, Kitajima T, Ivanics T, Delvecchio K, Mohamed A, Yeddula S, Collins K, Yoshida A, Abouljoud M, Nagai S, and Rizzari M. Combined liver and lung transplantation with extended normothermic liver preservation using TransmedicsOrgan Care System (OCS)™ liver: A single center experience. Am J Transplant 2021; 21(SUPPL 1):59.
Am J Transplant
Combined liver-lung transplantation (CLLT) is indicated in patients who cannot survive single-organ transplantation alone. Ex-situ normothermic machine perfusion (NMP) has been used to increase the pool of suboptimal donors and has been previously used for extended normothermic lung preservation in CLLT. We aim to describe our single-center experience using the 'Transmedics Organ Care System (OCS) ™ liver for extended normothermic liver preservation in CLLT.
Results [Values shown as mean (standard deviation)]: Four CLLTs were performed from 2015 to 2020 including 3 male and 1 female recipients, age 50 (±13.7) years (Table 1). Indications for lung transplantation: (1) cystic fibrosis (CF), (1) severe bronchiectasis, and (2) interstitial pulmonary fibrosis. Indications for liver transplantation: (1) biliary cirrhosis secondary to CF, (1) autoimmune hepatitis, (1) alcoholic cirrhosis, and (1) cryptogenic cirrhosis. The lung was transplanted first for all patients.
Recipient characteristics at transplant: Mean forced expiratory volume in 1 second (FEV1) was 51% (±22), and Model for End- Stage Liver Disease was 12 (±3.7). The livers were donated after brain death with donor age of 34 (±9.4) years and cold ischemia time 566 (±38) minutes. Ex-vivo pump time for the livers was 411 (±38) minutes (Table 2). Mean hospital stay was 34 days (±18). Over a median follow-up of 201 days, all patients were alive and doing well, while 50% had biopsy-proven acute cellular rejection of the liver.
Conclusion: Normothermic extended liver preservation is a safe method to prolong perfusion time and preserve the liver during combined organ transplantation.