One man’s ex­pe­ri­ence of cut­ting-edge tech­nol­ogy that could dou­ble the num­ber of vi­able liver trans­plants.

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For Ian Christie, time was run­ning out. Di­ag­nosed with cir­rho­sis of the liver – a con­se­quence of chronic liver dis­ease whereby liver tis­sue is re­placed by scar tis­sue, even­tu­ally lead­ing to loss of liver func­tion – the 62-year-old was told he had a max­i­mum of 18 months to live, un­less he had an or­gan trans­plant. But the wait­ing time for a liver that was suit­able was also 18 months long. “I was very wor­ried it was cut­ting it too fine and I wouldn’t get a trans­plant,” says Ian, from Devon, Eng­land.

But his life has been trans­formed af­ter he vol­un­teered to take part in a ‘world-first’ sur­gi­cal pro­ce­dure to test a new ma­chine that can keep a liver ‘alive’ out­side the hu­man body be­fore be­ing suc­cess­fully trans­planted into the re­cip­i­ent pa­tient.

At present, do­nated liv­ers can mostly only be used for trans­plants within 14 hours of be­ing re­moved if they are placed in ice to slow their me­tab­o­lism, but that can of­ten lead to or­gans be­com­ing dam­aged – and in some cases not be­ing suit­able for life-sav­ing trans­plant surgery by the time they reach the po­ten­tial re­cip­i­ent.

Un­der this new process, the do­nated hu­man liver is con­nected to an Or­gan Ox de­vice, which has been de­vel­oped by a team at Ox­ford Univer­sity in Eng­land, and raised to body tem­per­a­ture with oxy­genated red blood cells cir­cu­lated through its cap­il­lar­ies. Once on the ma­chine, a liver func­tions nor­mally just as it would in­side a hu­man body, re­gain­ing its colour and pro­duc­ing bile, and can be kept in a trans­plant-ready state for up to 24 hours.

The equip­ment is now be­ing clin­i­cally tri­alled at King’s Col­lege Hos­pi­tal in Lon­don, home to the largest liver trans­plant cen­tre in Europe and con­duct­ing more than 200 trans­plants a year on adults and chil­dren. In Fe­bru­ary this year, Ian be­came the first per­son in the world to re­ceive a trans­planted liver kept alive on the de­vice. So far the pro­ce­dure has been per­formed on eight pa­tients in the UK and all of them are mak­ing good progress.

But it wasn’t al­ways so pos­i­tive. At the time of his dev­as­tat­ing di­ag­no­sis in May 2012, Ian had the very real prospect of dy­ing from his con­di­tion. “At that point, I didn’t look that ill but I was strug­gling to work. My job as an elec­tri­cal con­tracts man­ager meant lots of meet­ings and travel so I couldn’t carry on with it,” he says.

The fa­ther of three daugh­ters, aged 25, 16 and eight, be­lieves his liver prob­lems can be traced back to his di­ag­no­sis 20 years ago with hep­ati­tis C, a liver-at­tack­ing virus he’s been liv­ing with ever since, and which he be­lieves he must have con­tracted through a blood trans­fu­sion fol­low­ing an ac­ci­dent in his teens.

Wait­ing for the phone to ring

Life on the trans­plant wait­ing list for Ian was, “Hor­ri­ble. Some­times I would for­get about the trans­plant but then I would catch sight of the hos­pi­tal bag in the cor­ner of the room that I had packed ready to go and then I would re­mem­ber,” he says. “You’re wait­ing for the phone to ring, won­der­ing ‘are they ever go­ing to call me?’”

And then one night an or­gan be­came avail­able and the trans­plant fi­nally went ahead, the only dif­fer­ence be­ing that the do­nated liver was put on the de­vice rather than placed on ice. Sup­ported by his wife De­bra, he de­cided to take part in the trial be­cause if the de­vice proved a suc­cess and could ben­e­fit more peo­ple in his sit­u­a­tion, it was his “duty to help”.

Ian vividly re­calls the mo­ment three days af­ter the trans­plant op­er­a­tion that Wayel Jassem, con­sul­tant liver trans­plant sur­geon at King’s Col­lege Hos­pi­tal, and the se­nior de­vel­op­ment team from Ox­ford, walked into his room with “beam­ing smiles” on their faces. “They look like they are nor­mally quite se­ri­ous gen­tle­men so I knew it was a good sign to see them so pleased,” Ian says. The trans­plant has been a rev­e­la­tion for him. “I feel bet­ter

than I’ve felt for 10 to 15 years.” He is hop­ing to get back to play­ing golf and cricket and sup­port oth­ers await­ing a trans­plant as a men­tor.

It’s been a long road to de­velop the de­vice, from the con­cep­tion of the idea two decades ago to the first trans­plant this year.

Pro­fes­sor Con­stantin Cous­sios of Ox­ford Univer­sity’s Depart­ment of En­gi­neer­ing Science and Pro­fes­sor Peter Friend, of Ox­ford Univer­sity’s Nuffield Depart­ment of Sur­gi­cal Sciences and Di­rec­tor of the Ox­ford Trans­plant Cen­tre, have been re­search­ing the tech­nol­ogy since 1994.

The re­sults from the first eight trans­plants are pos­i­tive and sug­gest the de­vice will ben­e­fit all pa­tients need­ing liver trans­plants. Based on pre-clin­i­cal data, the new de­vice could en­able the preser­va­tion of liv­ers that would oth­er­wise be dis­carded as un­fit for trans­plan­ta­tion – po­ten­tially dou­bling the num­ber of or­gans avail­able.

Pro­fes­sor Cous­sios says, “Th­ese first clin­i­cal cases con­firm that we can sup­port hu­man liv­ers out­side the body, keep them alive and func­tion­ing on our ma­chine and then, hours later, suc­cess­fully trans­plant them into a pa­tient. The de­vice is the very first com­pletely au­to­mated liver per­fu­sion de­vice of its kind: it was as­tound­ing to see an ini­tially cold grey liver flush­ing with colour once hooked up to our ma­chine and per­form­ing as it would within the body. What was even more amaz­ing was to see the same liver trans­planted into a pa­tient who is now walk­ing around.”

In ex­per­i­ments with the de­vice, the re­search team has shown they can pre­serve a func­tion­ing liver and mon­i­tor its func­tion out­side the body for up to 24 hours. This has sig­nif­i­cant im­pli­ca­tions says Dr Jassem, the sur­geon who per­formed the trans­plant op­er­a­tion on Ian. “There is al­ways huge pres­sure to get a do­nated liver to the right per­son within a very short space of time.

“For the first time, we now have a de­vice that is de­signed specif­i­cally to give us ex­tra time to test the liver, to help max­imise the chances of the re­cip­i­ent hav­ing a suc­cess­ful out­come. This tech­nol­ogy has the po­ten­tial to be hugely sig­nif­i­cant, and could make more liv­ers avail­able for trans­plant, and in turn save lives.”

The world watches and waits

The progress of the Lon­don tri­als is be­ing watched by sur­geons and liver spe­cial­ists across the world, in­clud­ing doc­tors in the UAE.

Two liver trans­plants have been con­ducted in the UAE in the past, ac­cord­ing to Dr Sameer Al Awadhi, spe­cial­ist gas­troen­terol­o­gist at Rashid Hos­pi­tal in Dubai and also at Cana­dian Spe­cial­ist Hos­pi­tal, but there is cur­rently no liver trans­plant surgery fa­cil­ity in the re­gion. How­ever there are plans to es­tab­lish a liver trans­plant pro­gramme in the UAE and re­cent dis­cus­sions among lead­ing clin­i­cians on the pro­posal have in­cluded the new Or­ganOx Me­tra.

Dr Mazin Al­jabiri, Con­sul­tant Gas­troen­terol­o­gist and Gen­eral Physi­cian at the Medi­clinic in The Dubai Mall Med­i­cal Cen­tre, and co-chair of the Liver Sci­en­tific Com­mit­tee for the Gulf Liver Sum­mit, said the plan is to es­tab­lish a part­ner­ship with Euro­pean sur­geons to help launch the liver trans­plant pro­gramme in the UAE within the next 18 months. Al­ready they have fo­cused on the in­fra­struc­ture needed and the clin­i­cal staff in ad­di­tion to sur­geons, haema­tol­o­gists and trans­plant co-or­di­na­tors.

“We are very ea­ger to start trans­plants here and es­tab­lish a trans­plant unit within the Medi­clinic in Dubai as soon as pos­si­ble but we want to make sure that it will be a suc­cess,” says Dr Al­jabiri.

He says there is pa­tient de­mand for such surgery and the role of the Or­ganOx Me­tra could be crit­i­cal. “That equip­ment will be im­por­tant for the trans­plant pro­gramme, it will be cru­cial to it be­ing suc­cess­ful.”

Dr Al Awadhi says he reg­u­larly sees pa­tients need­ing a liver trans­plant. At present such pa­tients travel abroad with a live donor, where part of the liver is trans­planted and re­gen­er­ates in the re­cip­i­ent. But he says that when a trans­plant pro­gramme is es­tab­lished in the UAE the spe­cial­ist equip­ment that will keep a do­nated liver alive and oxy­genated will be in­valu­able. “It looks very promis­ing,” he says.

Pa­tients need­ing liver trans­plant surgery in UAE are usu­ally suf­fer­ing from liver cir­rho­sis or auto-im­mune dis­ease and from the Rashid Hos­pi­tal alone there are 25 to 30 pa­tients a year re­quir­ing such surgery but some un­for­tu­nately die be­fore they get a trans­plant.

Pro­fes­sor Nigel Heaton, Con­sul­tant Liver Trans­plant Sur­geon and Di­rec­tor of Trans­plant Surgery at King’s Col­lege Hos­pi­tal, says, “If we can in­tro­duce this de­vice into ev­ery­day prac­tice, it could be a real game changer for trans­plan­ta­tion. Buy­ing the sur­geon ex­tra time ex­tends the op­tions open to our pa­tients, many of whom would oth­er­wise die wait­ing for an or­gan to be­come avail­able.”

In Europe and the US, 13,000 liver trans­plants are un­der­taken each year but the wait­ing list is about 30,000 with about a quar­ter of pa­tients dy­ing while they await trans­plan­ta­tion. Com­bined with that, more than 2,000 liv­ers are dis­carded ev­ery year be­cause they are ei­ther dam­aged by oxy­gen de­pri­va­tion or do not sur­vive cold preser­va­tion. But Pro­fes­sor Friend said the new tech­nique al­lows sur­geons to “qual­ity-as­sure” or­gans that would oth­er­wise be dis­carded, which could “in­crease the num­ber of trans­plants with­out in­creas­ing the risks”.

For Ian, the tech­nol­ogy has al­ready had an im­pact. “I’m get­ting bet­ter and bet­ter day by day, I just feel so alive.”

Ian Christie suf­fer­ing with liver cir­rho­sis be­fore his surgery, and af­ter he re­ceived the trans­plant in Fe­bru­ary this year

Ex­perts say the pro­ce­dure could dou­ble the num­ber of or­gans avail­able for trans­plant, and the ma­chine could soon be seen in the UAE

Ian, pic­tured with his wife De­bra and three daugh­ters, says he feels so alive since the ground-break­ing trans­plant. Left, the Or­ganOx Me­tra ma­chine pumps the liver with blood

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