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  1. Philip J Smith
  1. Department of Gastroenterology, Royal Liverpool Hospital, Liverpool Hospitals Foundation Trust, Liverpool, UK
  1. Correspondence to Dr Philip J Smith, Royal Liverpool Hospital, Liverpool Hospitals Foundation Trust, Liverpool, UK; Philip.Smith{at}liverpoolft.nhs.uk

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Basic science

A novel approach to optimising liver repair and increasing availability for transplant

Eshmuminov D, Becker D, Bautista Borrego L, et al. An integrated perfusion machine preserves injured human livers for one week. Nat Biotechnol 2020; 382: 189–198

Current normothermic approaches for perfusion of explant livers are an advance on previous static storage on ice, but still only preserve human livers for approximately 24 hours. Perfusion technology that could preserve livers in a metabolically active state for longer may allow poor quality livers sufficient time to repair to enable effective transplantation. In this study, Eshmuminov et al developed a liver perfusion machine that attempted to recapitulate and integrate several central host physiological functions, including automated management of glucose and oxygen levels, and removal of waste. To recreate the provision of gut nutrients and bile to the liver, parenteral nutrition and ursodeoxycholic acid were injected through the machine’s portal vein line. Applying the machine initially to the preservation of pig livers, the authors used stepwise refinements of machine algorithms, to the point where pig livers retained core hepatic functions after perfusion for 7 days without requiring additional blood products or the exchange of perfusate. Finally, the authors used their machine to perfuse 10 human livers that had been deemed unsuitable for transplant by European liver centres because of poor quality, and would have otherwise been discarded. After 7 days of perfusion, six of these livers appeared to have preserved/recovered liver function, as assessed by factors including synthesis of coagulation factors, production of bile and structural integrity. Further refinement of this technology may mean that liver grafts previously considered unsuitable for transplantation may become suitable for use, potentially reducing the transplant waiting list, and minimising adverse sequelae related to delayed graft function.

Whole-virome analysis in inflammatory bowel disease

Clooney A, Sutton T, Shkoporov A, et al. Whole-Virome Analysis Sheds Light on Viral Dark Matter in Inflammatory Bowel Disease. Cell Host Microbe 2019; …

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Footnotes

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; internally peer reviewed.

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