‘Liver in a box’ is saving lives with new technology

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Photo of transplant surgeons in the operating room monitoring a donor liver on a perfusion circuit. Photos requested to document the first liver pump transplant using the TransMedic Organ Care System to preserve donor liver intended for transplant.
Surgeons in the operating room monitoring a donor liver on a perfusion circuit

By Jason Howland

Liver transplant surgery is an option for a small percentage of people with early-stage liver cancer. A new technology called "liver in a box," is improving outcomes for patients who receive such lifesaving transplants.

"The technical name for it is 'normothermic mechanical perfusion,'" says Dr. Amit Mathur, a Mayo Clinic transplant surgeon.

Also known as "liver warm perfusion" or "liver in a box," it was approved by the Food and Drug Administration in late 2021 for use in the U.S.

"It describes a way of storing a liver when it is in the process of being recovered from the organ donor — from a deceased donor — to an organ transplant recipient," says Dr. Mathur.

In the past, the only way to do that was using cold preservation — keeping the liver on ice to slow down its metabolism. But liver warm perfusion preserves the organ differently.

"We're actually able to keep the liver alive in a box with oxygenated blood flowing through the blood vessels that supply the liver," says Dr. Mathur. "We're able to observe the organ being metabolically active, meaning the organ is still working."

Transplant teams at Mayo Clinic using liver warm perfusion say the early results are promising.

"We have found that patients are more stable during surgery, particularly at that critical moment when we restore blood flow to the new organ after extracting the old liver," says Dr. Mathur.

And in the postoperative phase, patients who receive a "liver in a box" are spending less time in the ICU. The technology also is being used for heart and lung transplants.

According to Lifesource, more than 11,000 people in the U.S. are waiting for a lifesaving liver donation.

Watch Dr. Amit Mathur discuss "liver in a box" in this "Mayo Clinic Minute" video:

For the safety of its patients, staff and visitors, Mayo Clinic has strict masking policies in place. Anyone shown without a mask was either recorded prior to COVID-19 or recorded in a nonpatient care area where social distancing and other safety protocols were followed.

A version of this story was originally published on the Mayo Clinic News Network.

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