The Lancet Regional Health. Western Pacific (Nov 2021)
Ischaemia-free liver transplantation in humans: a first-in-human trial
- Zhiyong Guo, M.D., Ph.D.,
- Qiang Zhao, M.D., Ph.D.,
- Shanzhou Huang, M.D., Ph.D.,
- Changjun Huang, M.D.,
- Dongping Wang, M.D., Ph.D.,
- Lu Yang, M.D., Ph.D.,
- Jian Zhang, M.Sc.,
- Maogen Chen, M.D., Ph.D.,
- Linwei Wu, M.D., Ph.D.,
- Zhiheng Zhang, M.D.,
- Zebin Zhu, M.D., Ph.D.,
- Linhe Wang, M.D.,
- Caihui Zhu, M.D.,
- Yixi Zhang, M.D., Ph.D.,
- Yunhua Tang, M.D., Ph.D.,
- Chengjun Sun, M.D.,
- Wei Xiong, M.D.,
- Yuekun Shen, M.D., Ph.D.,
- Xiaoxiang Chen, M.D.,
- Jinghong Xu, M.D.,
- Tielong Wang, M.D.,
- Yi Ma, M.D., Ph.D.,
- Anbin Hu, M.D., Ph.D.,
- Yinghua Chen, M.D., Ph.D.,
- Xiaofeng Zhu, M.D., Ph.D.,
- Jian Rong, M.D., Ph.D.,
- Changjie Cai, M.D., Ph.D.,
- Fengqiu Gong, M.P.H.,
- Xiangdong Guan, M.D., Ph.D.,
- Wenqi Huang, M.D., Ph.D.,
- Dicken Shiu-Chung Ko, M.D., Ph.D.,
- Xianchang Li, M.D., Ph.D.,
- Stefan G Tullius, M.D., Ph.D.,
- Jiefu Huang, M.D., Ph.D.,
- Weiqiang Ju, M.D., Ph.D.,
- Xiaoshun He, M.D., Ph.D.
Affiliations
- Zhiyong Guo, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China; Corresponding authors at: Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, NO. 58 Zhongshan Er Road, Guangzhou 510080, China; Tel: 86-20-87306082; Fax: 86-20-87306082.
- Qiang Zhao, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Shanzhou Huang, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Changjun Huang, M.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Dongping Wang, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Lu Yang, M.D., Ph.D.
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Jian Zhang, M.Sc.
- State Key Laboratory of Ophthalmology, Zhongshan Ophthalmic Centre, Sun Yat-sen University, Guangzhou 510080, China
- Maogen Chen, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Linwei Wu, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Zhiheng Zhang, M.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Zebin Zhu, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Linhe Wang, M.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Caihui Zhu, M.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Yixi Zhang, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Yunhua Tang, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Chengjun Sun, M.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Wei Xiong, M.D.
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Yuekun Shen, M.D., Ph.D.
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Xiaoxiang Chen, M.D.
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Jinghong Xu, M.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Tielong Wang, M.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Yi Ma, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Anbin Hu, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Yinghua Chen, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Xiaofeng Zhu, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China
- Jian Rong, M.D., Ph.D.
- Department of Cardiopulmonary Bypass, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Changjie Cai, M.D., Ph.D.
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Fengqiu Gong, M.P.H.
- Operating Room and Anaesthesia Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Xiangdong Guan, M.D., Ph.D.
- Surgical Intensive Care Unit, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Wenqi Huang, M.D., Ph.D.
- Department of Anaesthesiology, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China
- Dicken Shiu-Chung Ko, M.D., Ph.D.
- Department of Surgery, Steward St. Elizabeth's Medical Centre, Tufts University School of Medicine, Boston, MA 02115, USA
- Xianchang Li, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China; Immunobiology and Transplant Science Centre, Houston Methodist Research Institute, Houston, Texas 77030, USA
- Stefan G Tullius, M.D., Ph.D.
- Division of Transplant Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
- Jiefu Huang, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Department of Surgery, Peking Union Medical College Hospital, Beijing 100032, China
- Weiqiang Ju, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China; Corresponding authors at: Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, NO. 58 Zhongshan Er Road, Guangzhou 510080, China; Tel: 86-20-87306082; Fax: 86-20-87306082.
- Xiaoshun He, M.D., Ph.D.
- Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China; Guangdong Provincial Key Laboratory of Organ Donation and Transplant Immunology, Guangzhou 510080, China; Guangdong Provincial International Cooperation Base of Science and Technology (Organ Transplantation), Guangzhou 510080, China; Corresponding authors at: Organ Transplant Centre, The First Affiliated Hospital, Sun Yat-sen University, NO. 58 Zhongshan Er Road, Guangzhou 510080, China; Tel: 86-20-87306082; Fax: 86-20-87306082.
- Journal volume & issue
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Vol. 16
p. 100260
Abstract
Summary: Background Ischaemia-reperfusion injury is considered an inevitable component of organ transplantation, compromising organ quality and outcomes. Although several treatments have been proposed, none has avoided graft ischaemia and its detrimental consequences.Methods Ischaemia-free liver transplantation (IFLT) comprises surgical techniques enabling continuous oxygenated blood supply to the liver of brain-dead donor during procurement, preservation, and implantation using normothermic machine perfusion technology. In this non-randomised study, 38 donor livers were transplanted using IFLT and compared to 130 conventional liver transplants (CLT).Findings Two recipients (5•3%) in the IFLT group experienced early allograft dysfunction, compared to 50•0% in patients receiving conventional transplants (absolute risk difference, 44•8%; 95% confidence interval, 33•6-55•9%). Recipients of IFLT had significantly reduced median (IQR) peak aspartate aminotransferase levels within the first week compared to CLT recipients (365, 238-697 vs 1445, 791-3244 U/L, p<0•001); likewise, median total bilirubin levels on day 7 were significantly lower (2•34, 1•39-4•09 mg/dL) in the IFLT group than in the CLT group (5•10, 1•90-11•65 mg/dL) (p<0•001). Moreover, IFLT recipients had a shorter median intensive care unit stay (1•48, 0•75-2•00 vs 1•81, 1•00-4•58 days, p=0•006). Both one-month recipient (97•4% vs 90•8%, p=0•302) and graft survival (97.4% vs 90•0%, p=0•195) were better for IFLT than CLT, albeit differences were not statistically significant. Subgroup analysis showed that the extended criteria donor livers transplanted using the IFLT technique yielded faster post-transplant recovery than did the standard criteria donor livers transplanted using the conventional approach.Interpretation IFLT provides a novel approach that may improve outcomes, and allow the successful utilisation of extended criteria livers.Funding This study was funded by National Natural Science Foundation of China, Guangdong Provincial Key Laboratory Construction Projection on Organ Donation and Transplant Immunology, and Guangdong Provincial international Cooperation Base of Science and Technology.Panel: Research in context
