A world where no ischemia and reperfusion injury (IRI)?in organ transplantation has moved a step closer after scientists announced they had successfully performed the first transplantation procedure with continuous blood supply for the graft in human.

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Professor He Xiaoshun, of the department of organ transplantation at the first affiliated hospital of Sun Yat-sun University has become the first to perform the ischemia-free liver transplant in a patient with end-stage liver disease.

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Transplantation is one of the greatest achievements in the history of modern medicine. It has become the only means of treatment for vital organ failure. In the 63 years journey of transplantation, the issue of IRI remained one of the biggest problems. It is currently of much interest to the surgical even the whole medical communities due to its strong association with the clinical complication and outcomes. Although many efforts have been made to minimise the degree of IRI , the proof of concept in man have been found challenging.

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The team lead by professor He has successfully established a novel strategy could potentially “elude” all procedures leading to IRI rather than “reduce/minimise” the IRI effects, using a modified transplant procedure and NMP technique. This has been performed in nearly hundred cases of big animal studies with great success. In 23rd July?2017,，this novel strategy was first performed?in man.

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The patient who received the transplant was a 51-year-old man with decompensated cirrhosis and hepatocellular carcinoma in the left lobe, and the model for end-stage liver disease (MELD) score was 10. The donor was a 25-year-old man with confirmed diagnosis of brain death. During the implantation, the vessels were anastomosed without discontinuation of perfusion. No cold flush and storage were needed during whole procedure. Therefore, the oxygen and nutritional supply for the liver was sustained during organ procurement, preservation and implantation.

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Our post-transplant results demonstrate that for the first time in transplantation history, we are able to perform the transplant procedure without stoppage of blood supply for the graft in human. This first patient who underwent this procedure has a smooth and excellent recovery with an immediate functional liver graft without any further complication.

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This advance in surgical techniques set a milestone in the transplantation history. It uniquely brings together the technical and mechanical advances in the most recent surgical world. It offers the potential of extended-duration for liver preservation, optimizing liver function, measuring dynamic viability, and resuscitating compromised livers through drug delivery and gene therapy. The potential makes it a powerful tool for increasing organ utilization and improving transplant outcomes, particularly when using marginal donor organs. In addition, the platform can be utilised in other medical/life sciences area including but not limit to physiology, pharmacology, toxicology, immunology and oncology. Our results establish that it is feasible to achieve ischemia-free organ transplantation in human with a continuously functioning graft. We hope therefore that the work will be interest to you and the whole surgical and medical community.

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