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