Organ Preservation: Turning A Marginal Graft Into An Optimal One

Published Monday December 21, 2020

The emergence of living donors as sources of donated livers and kidneys has revolutionized the transplant field and saved many lives. However, with transplant increasingly recognized as the treatment of choice for many diseases, demand for donor organs has soared. For 12 consecutive years since 2008, more than 100,000 patients have ended the year on the waiting list, according to data from the Organ Procurement and Transplantation Network.

University Transplant Center and other programs are exploring more options, including the use of “marginal grafts.”

Marginal grafts receive that classification for a variety of reasons, including advanced age of the donor, hepatitis C infection in the donor, steatohepatitis (fatty inflammation of the liver), or prolonged warm ischemic time, to name a few.

“We can now transplant livers from donors who, for example, were infected with hepatitis C before their death,” said Francisco G. Cigarroa, MD, director of the University Transplant Center. “San Antonio is proving nationally that this can be done, and it can be done safely and expand the donor pool. Dr. Fred Poordad and Dr. Eric Lawitz, our partners from the Texas Liver Institute, are national leaders in hepatology and performed the important clinical trials that led to the approval of important antivirals against hepatitis C.”

Dr. Cigarroa believes the next 10 years will see important breakthroughs in organ preservation.

“How do we convert organs that are maybe too fragile to transplant because of instability of the deceased donor? How can we convert a liver or a kidney that we might not otherwise transplant into an optimal organ to transplant?” he asked. “That is the area of organ preservation research.”

Jennifer Milton, transplant center chief administrative officer, and University Health leaders collaborated to build the Center for Life at University Hospital. It is a space dedicated to increasing recovery of organs from deceased donors while enabling families to honor their loved ones in a timely way. The highly unique center, assisted by a generous gift from the Kronkosky Charitable Foundation, also includes a biorepository to further research.

“In the Center for Life, we are able to bring an interdisciplinary team to optimize the management of a deceased donor and thereby expand the number of available organs for transplant,” Dr. Cigarroa said. Community partners include the Texas Organ Sharing Alliance, which provides organ procurement and recovery services in South and Central Texas.

The biorepository will assist scientific discovery at the molecular level on how to convert marginal grafts into optimal ones. One idea is therapeutic perfusion, through which blood or other fluids are pumped through the blood vessels of the donor organ to ensure its viability.

“In our region of the world, metabolic syndrome is a big issue,” Dr. Cigarroa said. “This syndrome encompasses diabetes, obesity and hypertension. Metabolic syndrome often results in a fatty liver, and an excessively fatty liver is usually not a great liver to transplant.

“Imagine if you can intervene through perfusion, regenerate the liver cells and then transplant that organ?” he asked. “It’s not far away, and our partners at the Texas Liver Institute are doing significant clinical trials on the treatment of fatty liver. It may very well be that therapeutics will be developed that can help us in this quest to expand the number of deceased donor grafts to transplant.”

UT Health San Antonio, University Transplant Center and University Hospital are poised to be a leader in organ preservation because of the Center for Life, Dr. Cigarroa said.

Next: The First Transplant and Recipient