Liver trial: normothermic machine perfusion vs. cold storage in liver transplants
This is a randomised controlled trial comparing the current standard method for preserving a liver (in an ice box - static cold storage (SCS)) with a new technique called normothermic machine perfusion (NMP). This technology has been developed by Prof Peter Friend and Prof Constantin Coussios at Oxford University and the device is produced by OrganOx Ltd. The technique involves perfusing a liver with oxygenated blood, nutrients and medications at normal body temperature to preserve the organ in a functioning, physiological state.
A total of 222 livers have been randomised to the trial to either SCS or NMP in seven transplant centres in the UK, Spain, Germany and Belgium. If randomised to SCS the livers were stored in an ice box as per standard care and the retrieval and transplant will proceed in the conventional manner. If the organ was randomised to NMP then it was placed on the OrganOx machine from the time of retrieval, throughout its storage and transport, until it was eventually transplanted.
The primary outcome measure for the trial is the peak transaminase level (AST) within seven days post-transplant. Many secondary outcomes are being recorded including graft survival and function, MRCP evidence of iscaemic cholangiopathy and a health economic analysis at 3 months, 6 months and 12 months patient follow-up.
On 9 March 2016, the last liver required to reach the recruitment target was transplanted at the Queen Elizabeth Hospital in Birmingham (UK)! Since then, the trial results have been analysed and published. The trial has demonstrated that preserving livers at body temperature helps to improve transplant success and to increase the number of viable donor livers available for transplant, which could lead to shorter waiting lists for patients and lower mortality rates. This outcome was featured on the cover of the 3 May 2018 edition of the journal Nature, with additional coverage from the BBC and other outlets.
More detailed sub-studies on sample analysis are currently underway, along with data from the 24-month follow-up in the clinical trial.
POMP trial: oxygenated hypothermic kidney re-conditioning after cold storage
The objective of this randomised controlled trial is to evaluate pre-implantation reconditioning of donor kidneys from extended criteria donors (ECD) using oxygenated machine perfusion following cold storage. This study is led by Professor Andreas Paul from the University Clinic Essen in Germany and includes transplant centres in Germany, the UK, Belgium, The Netherlands and Hungary. The hypothermic trial device is provided by Organ Assist Products B.V. and the Centre for Evidence in Transplantation (University of Oxford, UK) has supported trial design and protocol development.
Once ECD donors are identified and randomisation is undertaken, the donor organ is placed in cold storage as per standard care irrespective of the randomisation outcome. However, if the kidney was randomised to hypothermic machine perfusion (HMP), it will be placed on the perfusion machine with oxygen for a minimum durtation of two hours prior to transplantation at the recipient centre. Kidneys randomised to static cold storage will stay in the standard care ice box without machine intervention until transplantation. The primary outcome measure in this project is death censored graft survival at one year, with secondary measures of delayed graft function in the first post operative week, graft function, primary non function and graft and patient survival at three months and one year. We are also recording the length of hospitalisation, and take biopsies for histology pre and post perfusion, plus biopsies of proven rejections.
POMP completed its recruitment in May 2018, and follow-up is underway until the 12-month trial endpoint. Proposals for sub-studies on samples from POMP are currently being accepted; see the Research page for further details.
COMPARE trial: oxygenated vs. non oxygenated hypothermic machine perfusion in kidney transplantation
This randomised controlled trial is designed to question whether oxygenated machine perfusion is superior to non-oxygenated machine perfusion in increasing the longevity and quality of older cardiac death donors (DCD) kidneys for transplant. The trial is led by Professor Jacques Pirenne and his team at the University Hospitals Leuven (BE) and includes transplant centres in Belgium, The Netherlands and the UK. The trial device is provided by Organ Assist Products B.V. and support has been given by the Centre for Evidence in Transplantation (University of Oxford, UK) in designing the study and writing the trial protocol.
The protocol sees DCD kidney pairs at donor centres immediately after procurement being randomised to hypothermic machine perfusion, one with oxygen, and one without oxygen. The organs are then transplanted into a recipient adult in end-stage renal failure on the active waiting list for a kidney only transplant. The primary outcome measure for this trial is long-term graft survival and secondary measures include primary non function, serum creanine at one, three and 12 months, functional delayed graft function as well as graft and patient survival.
The COMPARE trial has included a total of 105 transplanted kidney pairs and therefore reached its recruitment target in April 2017, with the 12-month follow-up endpoint reached in April 2018. Results of the trial are now available in The Lancet.