Northwestern Medicine introduces warm and cold liver perfusion for liver transplants
Innovative technology makes more donor livers usable for transplantation
The Northwestern Medicine Organ Transplant Center is now one of the largest transplant centers in the Midwest to use both warm and cold liver perfusion to make more livers available for lifesaving transplants. These advanced technologies improve donor liver quality and enhance the recovery process for patients at Northwestern Memorial Hospital.
To perfuse a donor liver, surgeons attach it to a machine that circulates either warm, oxygenated and nutrient-enriched blood or a cold, oxygen-rich solution. The technology helps transplant teams optimize the liver while it is being transported to its recipient.
“Our team has pioneered some of the first clinical trials as this rapidly evolving technology has been introduced in the United States,” said Daniel Borja, MD, a national leader in liver perfusion and a transplant surgeon at Northwestern Memorial Hospital. “Northwestern Medicine is among the leading transplant programs that are heavily investing in perfusion technologies because we have seen how patients recover faster and better when their livers have been perfused.”
The need for liver transplants in the United States far exceeds the supply of viable organs. More than 10,000 people are on the waiting list for liver transplants in the United States. In 2020, three patients died each day waiting for liver transplants. In the first six months of 2023, about half of the people who needed livers were able to receive them, according to the Organ Procurement & Transplantation Network.
“We are already the most experienced cold liver perfusion team in Illinois, and now that we are introducing warm perfusion, more patients will benefit,” Dr. Borja said. “They choose Northwestern Medicine for transplant care because they know we will do all we can to improve their health. When you’re suffering from liver failure, you want a team that will use the latest research and technology to make a healthier life possible.”
When you’re suffering from liver failure, you want a team that will use the latest research and technology to make a healthier life possible.
During warm (normothermic) perfusion, surgeons attach the donor liver to a machine that pumps warm, oxygenated and nutrient-enriched blood through the organ. While the liver is on the pump, the team assesses its function to ensure it is ideal for transplantation. This is especially important when the donor liver is classified as “marginal” or considered suboptimal for transplantation due to various criteria. While many transplant centers are forced to discard these organs, Northwestern Medicine’s team carefully evaluates them and is often able to find an appropriate patient match, thanks to perfusion technologies.
“Our team already has short liver waitlist times and low waitlist mortality rates, and warm perfusion will enable us to transplant even more patients, faster,” said Zachary Dietch, MD, transplant surgeon at Northwestern Memorial Hospital. “Now we’re able to expand our program because we can travel farther to procure a liver, place it on the pump and monitor its performance as we travel back to Chicago.”
A Northwestern Memorial Hospital team led by Dr. Borja is also part of a clinical trial using cold (hypothermic) perfusion to preserve livers for transplantation. For the study, surgeons attach the liver to a precision-controlled pump that circulates a chilled, oxygen-rich solution into the hepatic artery and portal vein. The liver’s mitochondria have a chance to repair as the solution circulates and the organ rests.
“The solution helps preserve and repair the liver so that by the time we place it in the patient, it is ready to work faster and starts working better,” Dr. Borja said. “So far, patients who have received perfused livers seem to be recovering faster and better than patients who received similar livers without machine perfusion.”
Dr. Borja said the team will continue to monitor patient outcomes for the FDA-approved warm perfusion and the cold perfusion clinical trial. Each patient will have a personalized treatment plan to achieve the best-possible results.
The heart, lung and kidney transplant teams at Northwestern Memorial Hospital also use warm perfusion technologies to preserve and assess organs. As the demand for organ transplantation grows, Northwestern Medicine continues to develop new ways to expand the pool of viable donor organs.
“The same diseases that are damaging the organs of our recipients are also affecting the donor population,” Dr. Borja said. “Diabetes, obesity, hypertension and other chronic conditions all affect the health of our donors, and we do all we can to make those organs usable for transplantation.”
Transplant surgeon Juan Carlos Caicedo, MD, says every scientific advancement is possible only because individuals and families make the selfless choice to donate organs.
“Organ donation, whether from a living donor or a deceased donor, is the greatest gift a person can receive,” Dr. Caicedo said. “We honor donors when we make more organs viable for transplantation. Research and innovation are helping our team maximize the possibilities.”