The evidence on ex-situ machine perfusion for extracorporeal preservation of livers for transplantation raises no major safety concerns. However, current evidence on its efficacy is limited in quantity. Therefore, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research.Find out what special arrangements mean on the NICE interventional procedures guidance page.
Clinicians wishing to do ex-situ machine perfusion for extracorporeal preservation of livers for transplantation should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients given a liver which has had ex-situ machine perfusion understand the uncertainty about the procedure's safety and efficacy, and provide them with clear written information to support shared decision making. In addition, the use of NICE's information for the public on ex-situ machine perfusion for extracorporeal preservation of livers for transplantation is recommended.
Audit and review clinical outcomes of all patients given a liver which has had ex-situ machine perfusion for extracorporeal preservation of livers for transplantation. NICE has identified relevant audit criteria and has developed NICE's interventional procedure outcomes audit tool (which is for use at local discretion).
Clinicians and centres doing this procedure must follow the relevant regulatory and legal requirements of the Human Tissue Authority.
Clinicians should enter details about all patients having this procedure into the NHS Blood and Transplant UK transplant registry.
Further research should report the exact method of perfusion used (such as hypothermic or normothermic), graft survival and the use of marginal grafts.