Led by Professor Chris Watson (Cambridge), Professor Andy Fisher (Newcastle) and Dr Sarah Hosgood (Cambridge), this theme focuses on the optimisation and implementation of novel perfusion technologies in organ transplantation. Both Cambridge and Newcastle have internationally recognised expertise in this area, covering all the major thoracic and abdominal organs. The overarching aims are to identify the best national system for delivering organ perfusion and develop a range of new interventions and therapies that can be delivered pre-transplantation to improve graft quality and longevity.
Major workstreams under this theme are:
- Implementation of perfusion technologies: We will generate proof-of-concept data to determine the feasibility of establishing Assessment and Repair Centres (ARCs) to deliver a normothermic machine perfusion (NMP) service. If pilot data establishes the safety, feasibility and cost-effectiveness of ARCs we anticipate working with NHSBT to establish a national service. In parallel, and in collaboration with NHSBT, we will develop a national normothermic regional perfusion (NRP) service to include protocols, governance structure and training.
- Optimisation of perfusion parameters: We will identify assessment criteria enabling optimal use of perfusion technologies. Perfusion will be extended up to 24 hours and beyond, facilitating delivery of advanced therapies that will lead to changes at the level of protein expression. The intention is to translate these strategies into clinical practice within 5 years.
- Pre-transplant interventions and repair: We will investigate NMP delivery of novel pre-transplant interventions with the potential to transform transplantation. For example, enzymatically converting donor organs to universal ABO group O (to improve access to transplantation in ethnic minorities), preventing cytomegalovirus (CMV) reactivation, and organ repair using drug, cell and gene therapies.
- National Donor Organ Perfusion Registry: Working with NHSBT we will establish a National Donor Organ Perfusion Registry for detailed analyses of outcome and as a platform to deliver randomised clinical trials utilising the ‘RECOVERY’ model established to perform COVID research.
- Increasing the number of organs available
- Improving organ quality and long-term outcome
- Enhancing access to transplantation
Developing and refining perfusion technologies will increase the number of organs available by identifying those that will function satisfactorily post-transplant, so reducing the number that are declined for transplantation because of doubts over quality. Further patient benefit will be realised through pre-transplantation repair and treatment of isolated organs during perfusion to improve organ quality and long-term outcome. This targeted type of approach can avoid the complications of systemic delivery of drugs and therapies. It also has the potential to address inequalities in access to transplantation. For example utilising enzyme delivery during kidney NMP to generate universal donor group O organs could transform clinical practice by minimising the need for national organ exchange programmes and ABO incompatible transplants. This especially impacts ethnic minority groups who currently have reduced access to transplantation due to high prevalence of blood group B as only 10% of donor kidneys are group B.