This trial will examine the safety and feasibility of using the OrganOx Metra device to transport and store donor livers under normothermic conditions prior to transplantation. Participants will be followed for 3 months following transplantation and their outcomes recorded.
Liver transplantation is a life-saving procedure but its success has been limited by a shortage of suitable donor organs. Much emphasis is now placed on optimising the condition of those organs that are available, to enable more higher risk organs to be transplanted safely. An effective means of pre-transplant viability assessment would not only allow greater use of higher risk donors but also minimise the risk of primary non-function by identifying and excluding non-viable organs before subjecting a patient to the risk of surgery. Organ storage under normothermic perfusion conditions enables organ function to be evaluated prior to transplantation and further has been shown to prevent organ injury which is sustained during standard cold storage. This trial will examine the safety and feasibility of using the OrganOx Metra device to transport and store donor livers under normothermic conditions prior to transplantation. This study will evaluate liver function post-transplantation using standard clinical parameters. Participants will be followed for 3 months following transplantation and their outcomes recorded. Participants will undergo no other study procedures. Feasibility will be measured using the ratio of actual / eligible candidate donors recruited to the study and will also encompass logistical issues with respect to transportation, and ease of use. Safety will be assessed by rates of device failures resulting in organ discard, primary graft non-function, re-transplantation, and recipient death.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
OTHER
Masking
NONE
Enrollment
40
Normothermic machine perfusion (NMP) Metra device
Toronto General Hospital
Toronto, Ontario, Canada
Rates of primary graft non-function
Time frame: 3 months
Rates of re-transplantation
Time frame: 3 months
Rates of recipient death
Time frame: 3 months
Rate of device failures resulting in organ discard
Time frame: 3 months
Recruitment rates to the study
Measured by the ratio of actual / eligible candidate donors recruited to the study
Time frame: 3 months
Ischemia- reperfusion injury associated with organ storage
Assessed by a post-perfusion biopsy
Time frame: 7 days
Ischemia- reperfusion injury associated with organ storage
Assessed by measuring the peak serum aspartate transaminase level (AST) within 7 days post-transplant
Time frame: 7 days
The function of liver grafts stored with the Metra™ device
Measured by bilirubin, alkaline phosphatase, AST and INR levels at days 1-7 post-transplant. The measure is a composite.
Time frame: 3 months
The function of liver grafts stored with the Metra™ device
Measured by bilirubin, alkaline phosphatase, AST and INR levels at day 30 post-transplant. The measure is a composite.
Time frame: 3 months
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The function of liver grafts stored with the Metra™ device
Measured by bilirubin, alkaline phosphatase, AST and INR levels at month 3 post-transplant. The measure is a composite.
Time frame: 3 months
The function of liver grafts stored with the Metra™ device
Measured by Lactate at days 1-3 post-transplant. The measure is a composite.
Time frame: 3 months
The ability of perfusion parameters to predict clinical outcomes following transplantation
Perfusion flows and pressures will be studied to determine their correlation with graft injury and function. The measure is a composite.
Time frame: 3 months
The ability of perfusion parameters to predict clinical outcomes following transplantation
Perfusate blood gas parameters will be studied to determine their correlation with graft injury and function. The measure is a composite.
Time frame: 3 months
The ability of perfusion parameters to predict clinical outcomes following transplantation
Bile production will be studied to determine their correlation with graft injury and function
Time frame: 3 months