The operation: a transplantation

Organ transplantation is a lifesaving therapy for patients suffering from end stage organ failure. The UMCG is the largest transplant centre in the Netherlands and is the only centre performing transplantation of all solid organs. Transplantation is a multidisciplinary treatment in which a team of specialists work closely together. To ensure optimal patient outcome, organ-specific knowledge in terms of both physiology and anatomy is essential. In addition, knowledge about donor management and optimization, donor organ preservation, post-transplantation (ICU) management and quality of life are all relevant aspects that require continuous research and development.

On average there are about 1000 kidney transplantations a year in the Netherlands, of which 180-200 are performed at the UMCG. About half of these transplanted kidneys come from a living donor. Currently 719 people are waiting for a donor kidney in the Netherlands. The number of kidney transplantations is increasing, mainly due to an increase in living donors and re operations on previously transplanted kidney recipients. The second largest transplant program in the UMCG is liver transplantation. The number of liver transplantations increased with 20% last year, from 56 to 73 liver transplantations per year.

This increase is available organs is inter alia determined by the introduction of machine perfusion techniques. This technique allows assessment and resuscitation of otherwise rejected organs. With this innovative organ preservation technique, developed in the UMCG, it is possible to make more kidneys and livers suitable for transplantation.

What are machine perfusion techniques? In kidney grafts, hypothermic machine perfusion is currently the gold standard for preservation in the Netherlands. A large multicentre study on the use of normothermic machine perfusion in kidneys is currently being performed in the Netherlands, including the UMCG.

Liver machine perfusion exists of a hypothermic and a normothermic part. With hypothermic perfusion an extended flushout of potentially harmful metabolites is obtained with adequate cooling to reduce metabolism. With the normothermic part, warm fluid is pumped through the liver and hereby resuscitates the organ. The normothermic fluid, which is pumped through the liver after the hypothermic part, enables hepatobiliary viability assessment prior to transplantation.

The impact of an organ transplant on patients is enormous. Their quality of life as well as their life expectancy increases significantly after the transplantation. With the innovative technique of machine perfusion, more organs become available for transplantation and therefore more people can be treated, waiting lists can be shortened, and maybe eventually make them belong to the past.

If you want to know more about the transplantation and perfusion techniques, visit the ISCOMS operation on Thursday the 6th of June.