Researchers will assess whether removing fat from donor livers could make them suitable for transplantation, in a trial with potentially groundbreaking implications for liver disease patients.
The DeFat study, led by Professor Peter Friend at the University of Oxford and consultants at London’s Royal Free Hospital, will examine whether an innovative “defatting” strategy could help increase the number of livers that are suitable for transplantation in the future.
Liver disease is currently the third leading cause of premature death in the UK and once patients reach the final stages of the disease, transplantation is the only potential cure.
There is currently a shortage of suitable donor organs, meaning that not every patient in need of a transplant can receive one.
Around a third of all donated livers which are declined for transplants are discarded due to the presence of fat within the liver cells, known as non-alcoholic fatty liver disease (NAFLD).
For the DeFat trial, 60 livers will be preserved on a machine in very similar conditions to the body – known as “normothermic machine perfusion”. A combination of drugs will be used to release fat from the liver cells, while the fat will be removed from the perfusion machine using a specialised filter. This will reduce the amount of fat in the liver and improve its function.
The livers will be provided by donors with a high risk of fatty liver disease.
Some will be preserved in an NMP alone, while others will be transferred to an NMP with fat removal treatment.
The study will then assess how many of these livers are safe to transplant and, in those that are then transplanted, what the outcomes were for patients after the operation.
Clinicians hope to figure out whether the treatment is safe, and whether its results could help design a future study which will test the extent to which fat removal actually leads to additional transplants.
There are no anticipated side effects or risks related to the preservation and defatting process itself on the machine, as all defatting agents are flushed from the liver before transplantation.
The liver transplant team at London’s Royal Free Hospital have successfully recruited the first liver to be used in the study.
The trial is being led by Professor Joerg-Matthias Pollok and Mr. David Nasralla at the RFH, along with Prof Friend.
Prof Pollok said: “This is a potentially ground-breaking study for people waiting for a liver transplant as it might enable us to significantly increase the number of livers which are suitable for transplantation in the future.
“As obesity rates in the population are on the rise, we are seeing more livers with NAFLD in the donor pool which unfortunately we currently have to reject for donation. We will continue to support the study as suitable livers become available and we look forward to assessing the results and what this could mean for our patients awaiting transplant going forward.”
