National Institute for Health and Clinical Excellence (NICE)
More donor livers could be used for transplantation thanks to exciting new development, NICE says
Procedure will extend the life of a donor liver by double the length of time compared to now.
A procedure assessed by NICE has been hailed as an “exciting development” in increasing the number of livers which can be safely used for transplantation.
A perfusion machine can keep the donated liver viable for transplantation for longer. The machine reduces the rate of tissue deterioration that occurs after the liver has been removed from the donor and extends how long the liver can be stored before transplantation.
Variations of the technique can also allow the liver to be flushed with blood at body temperature and supplied with oxygen, medications and nutrients allowing its viability and function to be assessed.
It is hoped machine perfusion could increase the number of organs viable for transplant, saving more lives and reducing liver transplant waiting lists.
Liver transplantation is a highly successful treatment for end-stage liver disease, which kills 11,000 people a year in England. Deaths from liver disease have soared by 25 per cent in a decade and continue to rise, while the average age of death from liver disease (currently 50-59 years) continues to decrease.
Today (Wednesday 16 January) NICE has issued final guidance which recommends the procedure — ex-vivo machine perfusion for extracorporeal preservation of livers for transplantation — is used under special arrangements as more data is gathered into its efficacy.
NICE’s independent advisory committee did not identify any major safety concerns.
Surgeons undertaking the procedure must inform patients about the uncertainty of the procedure’s efficacy, comply with the relevant regulatory and legal requirements of the Human Tissue Authority and should enter details about all patients having this procedure into the NHSBT UK transplant registry.
Professor Kevin Harris, programme director and clinical advisor for the Interventional Procedures Programme at NICE, yesterday said:
“This procedure offers hope for patients needing a liver transplant. It offers another way of preserving the liver, and assessing whether livers which might have previously been considered unsuitable, can be used safely.
“The latest evidence reviewed by a NICE committee concluded that the procedure worked well and was safe to be offered to patients who had been fully informed of the risks and benefits. Clinicians should seek approval from their trust’s management and record all data from the procedure in a database.
“By using this procedure, more patients on the organ transplant waiting list could be offered a chance of a transplant and there-by potentially extending their lives.”
Sue Bennett, 45, a mother of three from Ranton in Staffordshire, had a liver transplant using this new technique in 2015. She said:
“I signed up for the trial not knowing I would be one of the first to have this procedure in the country. Before my transplant I was very ill. I was losing weight, I couldn’t sleep and my quality of life was quite low.
“I had a transplant after the hospital found a donor who was a match. The liver was kept alive using this procedure overnight and I was able to have the operation the following day. Nine days later I was back home.
“Having a transplant has changed my life. I‘ve joined the gym, got fit and gone back to work and did some voluntary work for the Staffordshire Search and Rescue team and I also compete nationally and internationally in the Transplant Games as a member of the Team GB transplant team.
“My life is unbelievably wonderful. I’m very healthy, I’m very happy and very active. I think I‘ve been very lucky.”
University of Birmingham professor Darius Mirza, transplant surgeon at University Hospital's Birmingham NHS Foundation Trust, said:
"In the 30 years I've been involved with transplantation there have been three or four events which have been game changers and I'm absolutely certain we are looking at a game changer that will change the way we practice organ storage and transplantation.
"It is already changing practice at the centres that have been able to use this technology either within clinical trials or within an expansion of service evaluation."
John Forsythe, associate medical director at NHS Blood and Transplant, said:
“There has been a huge amount of research in the area of preservation and perfusion methods that allow us to both assess precious donor organs and to enhance their function. This could potentially mean the organ works better and improve transplant outcomes.
“Many of the lead researchers in the area of transplant preservation and perfusion techniques are in UK and it is good to see UK researchers continue to be at the forefront in this field.
“Transplantation wouldn’t be possible without the generosity of organ donors and their families.”
Vanessa Hebditch, director of policy at the British Liver Trust said,
“Every year hundreds of people with advanced liver disease die whilst waiting for a transplant.
“This new device offers real hope as it may improve transplant outcomes and allow livers that were previously thought to be unsuitable to be used and also increase the time that livers are able to be kept.
“It is an exciting development that has the potential to shorten waiting list times and reduce mortality rates from advanced liver disease. After transplant, the vast majority of people go on to lead full and healthy lives and it is truly amazing to see the transformation.”
NHS England and commissioners will decide whether they fund the procedure. However research is already taking place at the University of Birmingham and Queen Elizabeth Hospital Birmingham and other transplant centers across the country.
For the financial year ending 31 March 2018, there were 1,043 liver transplants in the UK and 359 patients on the UK active transplant list, according to NHS Blood and Transplant.
The number of patients on the active transplant list reached a ten year high in 2015 when 611 patients were on the waiting list. However the large drop attributed to the 2018 figure may be due to the introduction of the National Liver Offering Scheme (NLOS) in March 2018.
Latest News from
National Institute for Health and Clinical Excellence (NICE)
NICE commissions expert advice on EQ-5D-5L22/05/2019 12:15:00
Blog posted by: Rosie Lovett, Science policy and research programme, 21 May 2019.
Shared Learning Awards 2019: Winning example announced21/05/2019 16:15:00
Pancreatic Cancer UK and University Hospital Birmingham pick up first prize.
NICE recommends first ever treatment for children with rare muscle-wasting condition16/05/2019 11:15:00
Children with the rare genetic disorder spinal muscular atrophy (SMA) can now be treated with nusinersen after NICE yesterday (15 May) recommended it following agreement of a deal between the company, Biogen, and NHS England.
Lower price for MS drug paves the way for positive recommendation from NICE10/05/2019 12:15:00
A new, lower price for a drug to treat a rarer form of multiple sclerosis in adults has paved the way for its approval by NICE.
The Scarred Liver Project: A new diagnostic pathway to detect chronic liver disease09/05/2019 10:42:00
Blog posted by: Neil Guha, clinical associate professor in hepatology, Nottingham University Hospitals NHS Trust, 08 May 2019.
The perinatal mental health (PMH) matrix: Improving the quality of care for women with PMH issues08/05/2019 16:48:00
Blog posted by: Sarah Fishburn, quality improvement lead, Thames Valley Strategic Clinical Network, 08 May 2019.
Demand faster treatment: Why people with pancreatic cancer simply cannot afford to wait08/05/2019 14:51:00
Blog posted by: Anna Jewell, director of services, Research and Influencing, Pancreatic Cancer UK, 08 May 2019.
New NICE guideline will help doctors recognise and refer people with suspected neurological conditions02/05/2019 09:15:00
NICE’s new guideline is the first to offer comprehensive information on neurological conditions to help non-specialist healthcare professionals to identify people who should be referred for specialist assessment and care.
NICE launches online resource to help development and adoption of new health technologies29/04/2019 14:15:00
HealthTech Connect, a new online resource provided by NICE to help identify and support new health technologies as they move from inception to adoption in the UK health and care system was formally launched today (29 April).