Liver disease is currently the third leading cause of premature death in the UK and once patients reach the final stages of the disease, transplantation is the only potential cure. However, because there is a shortage of suitable donor organs, not everyone who needs a transplant can receive one.
Currently a third of all donated livers which are declined for transplants are discarded due to the presence of fat within the liver cells – known as non-alcoholic fatty liver disease (NAFLD). This is because fatty livers do not tolerate being stored and transported in an icebox and are therefore not likely to result in a successful transplantation.
However, the DeFat study, run by Mr Hussain Abbas and led by Professor Peter Friend and Mr Simon Knight at Nuffield Department of Surgical Sciences, is aiming to understand whether an innovative ‘defatting’ strategy will make fatty livers more suitable for transplantation.
As part of the trial, the livers will be preserved on a machine in very similar conditions to those in the body (termed normothermic machine perfusion; NMP). A combination of currently available drugs are used to release fat from the liver cells and the fat is removed from the perfusion machine using a specialised filter. This reduces the amount of fat in the liver and improves its function.
The trial involves the random assignment of 60 livers from donors with a high risk of fatty liver disease to either NMP alone or NMP with fat removal treatment. The study will then assess how many of these livers are safe to transplant and, in those that are then transplanted, follow the outcomes after the operation.
The main objective is to show whether this treatment is safe; it is also hoped it will help to design a future, larger study which will test the extent to which fat removal actually leads to additional transplants.