New machine to boost liver transplants at Addenbrooke’s - 50 years after first procedure

PUBLISHED: 08:35 07 May 2018 | UPDATED: 08:52 07 May 2018

From left, Professor Chris Watson and Hon Consultant Andrew Butler with the new perfusion machine. Picture: Keith Heppell

From left, Professor Chris Watson and Hon Consultant Andrew Butler with the new perfusion machine. Picture: Keith Heppell

Iliffe Media Ltd

£250,000 fundraising drive for perfusion machine at Cambridge hospital

From left Professor Chris Watson and ACT Chief Executive Shelly Thake in one of the wards. Picture: Keith HeppellFrom left Professor Chris Watson and ACT Chief Executive Shelly Thake in one of the wards. Picture: Keith Heppell

Ground-breaking work to boost the number of liver transplants has been given a massive boost – 50 years to the day after Europe’s first successful procedure was undertaken by Professor Sir Roy Calne at Addenbrooke’s Hospital in Cambridge.

Addenbrooke’s Charitable Trust (ACT) has today (Wednesday) announced the launch of a £250,000 appeal to trial and run a state-of-the art ‘liver perfusion’ machine.

The machine will help newly donated livers survive for longer and, crucially, enable doctors to test how well they function, boosting the chances of successful transplants.

It also means that livers that might otherwise be dismissed as unsuitable, including those from older donors, could be deemed healthy enough to save a life.

Transplant pioneer Professor Calne, who led the first transplant on May 2 1968, dedicated his life to turning seemingly impossible surgery into regular practice at the trust.

In the early years of pioneering liver transplants, he had to battle against all the odds to ensure his work would reach fruition with one animal rights group sending his family a letter bomb in protest at his research.

Today, Wednesday May 2, Addenbrooke’s will host a celebration to mark the 50th anniversary of that first procedure, as well as celebrate the latest machine to aid liver transplants.

Liver perfusion involves pumping blood through the organ, mimicking in simple terms what happens in the body, which preserves it and allows its function to be tested. Livers can be kept outside the body for up to 24 hours as opposed to 6-12 in cold storage.

The charity agreed to an appeal after learning of a trial by Addenbrooke’s transplant consultant, Professor Chris Watson, and consultant hepatologist, Mike Allison, who have successfully treated 14 patients over 12 months using perfused livers – many of them rejected by other centres.

From left Professor Chris Watson, and Hon Consultant Andrew Butler with the new machine.  Picture: Keith HeppellFrom left Professor Chris Watson, and Hon Consultant Andrew Butler with the new machine. Picture: Keith Heppell

The cash will pay for consumables, such as clean pipes, for the machine which need to be replaced before every new procedure at a cost of £4,500 each time.

Addenbrooke’s will be the only liver transplant centre in the UK to use the perfusion technique as part of its standard clinical practice.

ACT chief executive Shelly Thake said: “When Professor Watson and his colleagues told us about their incredible cutting edge work with liver perfusion we wanted to do all we could to help.

“The liver perfusion machine will allow potentially an additional 54 transplants to be carried out over two years. That’s 54 people being given the chance of a better quality of life. It is apt that this appeal coincides with the 50th anniversary of the first successful liver transplant in Europe and we think the public will embrace it.

“We hope this equipment becomes part of the NHS core service. Every time a liver is put onto the machine they have to use a single-use pack which helps to ensure patient safety and cut down the risk of infection. Each pack costs around £4,500. It is essential we have those packs and that is why we need the money.”

Sir Roy, who was knighted in 1986, said: “The new machine is a big advantage and it has taken a lot of hard work. It allows the appraisal of a liver to see if it is going to work or if it has been damaged by the lack of blood supply.

“It allows a liver to be taken from Cambridge to Birmingham for example or vice-versa, or to anywhere a patient is waiting. I am delighted with what they have done and how far they have got.

“In my day we went from hand to mouth so to speak in terms of liver availability, but by using this machine, operations can be scheduled.

“We were doing general surgery, kidney and liver transplants and we might on occasions thought we had finished for the day, but then went on into the evening and into the night when livers became available.

From left, ACT chief executive Shelly Thake, Professor Sir Roy Calne, Professor Chris Watson and Hon Consultant Andrew Butler with the new machine. Picture: Keith HeppellFrom left, ACT chief executive Shelly Thake, Professor Sir Roy Calne, Professor Chris Watson and Hon Consultant Andrew Butler with the new machine. Picture: Keith Heppell

“There was extreme pressure to go to the next case when you were still recovering from the last one, and that is beginning to be removed because of this.”

As a child in Surrey, Prof Calne, who received the Pride of Britain Lifetime Achievement award in 2014, chose painting as a hobby and some of his work now adorns the walls of the hospital, close to the bust of him made by sculptor Laurence Broderick.

The advances in transplant techniques are appreciated by Prof Calne who admits that he longed to be back at the cutting edge when he retired.

During his career, he saved the lives of thousands of patients and yet, even now, at the age of 87, he is still pioneering new treatments, this time for diabetic sufferers.

“I missed it enormously to begin with,” said Prof Calne. “Then I became interested in research relating to some aspects of diabetes. Now I am involved in a fairly active, challenging research programme for changing diabetes with gene therapy.

“I have a lab in Singapore and we are collaborating with a group in London and Cambridge, which has recently made quite a bit of progress.

“We have adopted a method of getting the gene into the liver of the diabetic patient and the gene then persuades the liver cells to take on the new additional workload of producing insulin. This has worked very well in diabetic mice once we got the dose right.

“The medical world has made some extraordinary advances since that first transplant 50 years ago and I am proud to come back to Addenbrooke’s and learn that the trust is still pioneering new techniques to help patients.”

Prof Calne, who still lives in the Cambridge area, unveiled a new hospital museum display dedicated to the history of transplant and which emphasises the all-important part that donors play in the process.

Live transplants have been carried out for 50 years at Addenbrooke's Hospital. Picture: Keith HeppellLive transplants have been carried out for 50 years at Addenbrooke's Hospital. Picture: Keith Heppell

Guests, including current and former clinicians and patients, learned about an audio project, backed by Sharing Heritage Lottery Funding, which will capture the memories of those touched by transplant in Cambridge. Ultimately it will feature in the British Museum.

In the afternoon, CUH staff past and present, and other specially invited guests, met for a tea party hosted by trust chairman Dr Mike More, to celebrate the achievements of the past 50 years – consolidating the posi-tion of Addenbrooke’s Hospital as a world leader in the field of transplant.

Addenbrooke’s liver specialist Professor Chris Watson knows he is standing on the shoulders of a giant in Sir Roy Calne, but the surgeon is set to take transplants into a new era thanks to a machine which has its design origins in Cambridge. The perfusion machine will ensure livers are fit for purpose and save countless lives in the years ahead. The initial research and work on the circuitry for the machine to produce human liv-ers with human blood was perfected by consultant Andrew Butler. Around 10 per cent of people on the liver transplant waiting list either die before a donor is found and a further seven per cent deteriorate to such an extent that they are no longer well enough to undergo a transplant and removed from the list. But now there is more help on the way. Prof Wat-son, consultant transplant surgeon, said: “Perfusion is the next important step forward in liver transplantation and we are incredibly grateful to the ACT for supporting this life-saving work.

“If you have a liver stored in ice it is still metabolically active, but ultimate-ly the energy supply will run out and it will not be able to function when you transplant it.

“The beauty of this machine is you can restore a blood supply and replenish a liver’s energy levels to allow it to function normally.”

But despite his own pioneering work, Prof Watson is quick to distance himself from any similarity with the legend that is Sir Roy Calne.

He said: “Sir Roy is exceptional but we are trying to continue to innovate. At the moment, we turn down three out of 10 livers offered to us because we are not sure they are going to work.

“This machine will allow us to use more livers by testing them first to show they are working before we undertake a transplant.

“We hope to be able to do up to 40 transplants a year thanks to this machine. We know some of the livers we get will be good anyway but there are some we need to put on the machine to be sure they are good enough to use. We will be able to perform more transplants on patients.

Anatomy of the liver and blood supplyAnatomy of the liver and blood supply

“Transplantation is a fabulous specialism to be in because one in eight patients are dying before your eyes, but we can transform their lives for decades longer. Being able to put a new liver into someone makes such a difference to the patient.”

Anyone who wants to make a donation to the ACT appeal can visit act4addenbrookes.org.uk/transplant.

Pioneering machine restores blood supply

Addenbrooke’s liver specialist Professor Chris Watson knows he is standing on the shoulders of a giant in Sir Roy Calne, but the surgeon is set to take transplants into a new era thanks to a machine which has its design origins in Cambridge.

The perfusion machine will ensure livers are fit for purpose and save countless lives in the years ahead. The initial research and work on the circuitry for the machine to produce human livers with human blood was perfected by consultant Andrew Butler.

Around 10 per cent of people on the liver transplant waiting list either die before a donor is found and a further seven per cent deteriorate to such an extent that they are no longer well enough to undergo a transplant and removed from the list.

But now there is more help on the way.

Prof Watson, consultant transplant surgeon, said: “Perfusion is the next important step forward in liver transplantation and we are incredibly grateful to the ACT for supporting this life-saving work.

“If you have a liver stored in ice it is still metabolically active, but ultimately the energy supply will run out and it will not be able to function when you transplant it.

“The beauty of this machine is you can restore a blood supply and replenish a liver’s energy levels to allow it to function normally.”

But despite his own pioneering work, Prof Watson is quick to distance himself from any similarity with the legend that is Sir Roy Calne.

He said: “Sir Roy is exceptional but we are trying to continue to innovate. At the moment we turn down three out of 10 livers offered to us because we are not sure they are going to work.

“This machine will allow us to use more livers by testing them first to show they are working before we undertake a transplant.

“We hope to be able to do up to 40 transplants a year thanks to this machine. We know some of the livers we get will be good anyway but there are some we need to put on the machine to be sure they are good enough to use. We will be able to perform more transplants on patients.

“Transplantation is a fabulous specialism to be in because one in eight patients are dying before your eyes, but we can transform their lives for decades longer. Being able to put a new liver into someone makes such a difference to the patient.”

What is liver perfusion?

There are two types of perfusion techniques, hypothermic (between 4°c and 10°c) and normothermic (35°c and 37°c).

The latter technique, which mimics what happens to the liver in the body, is used at Addenbrooke’s and provides more information regarding the liver function and how it is going to respond to transplantation.

The advantage of using the perfusion technique, where blood supply is provided to the liver, is that tests can be performed to see how well the liver will function after transplantation.

It also means livers can be stored for longer – up to 24 hours – which reduces the risk of an available organ not being used because, for example, surgeons are in theatre with another transplant.

Clinical trials are taking place to see if there are further tests that can be carried out on perfused livers to determine how well it will function, or convert livers once considered unsafe to transplant into life-saving organs.

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