Dual-compartment monitoring strategy improves evaluation of donor human livers

More than 100,000 people in the United States are waiting for a lifesaving organ transplant. For patients in need of a liver transplant, determining whether a donor liver is healthy enough to transplant is a critical part of the process.

Yangzhi Zhu, PhD, Principal Investigator and Assistant Professor at the Terasaki Institute for Biomedical Innovation, and collaborators at Mayo Clinic in Arizona have developed a real-time biosensing platform designed to help answer that question during donor liver preservation. The study, published in Nature Communications, reports a wireless dual-compartment biochemical monitoring platform that continuously measures key biomarkers in both perfusion fluid and bile during normothermic machine perfusion (NMP).

Liver transplantation remains limited by the shortage of suitable donor organs and the lack of a precise method for determining organ viability before surgery. NMP allows donor livers to be maintained outside the body under warm, oxygenated conditions, giving transplant teams an opportunity to evaluate organ function before transplantation. However, current assessment methods often rely on intermittent sample collection and laboratory testing, which provide only periodic snapshots of organ status.

The new platform addresses this limitation by enabling continuous, real-time biochemical monitoring during perfusion. Integrated into the clinical perfusion workflow, the system measures pH, glucose, and lactate from both the circulating perfusion and bile produced by the liver. These measurements are transmitted wirelessly to a mobile interface, allowing researchers and clinicians to observe dynamic metabolic changes as they occur.

In a pilot study conducted at Mayo Clinic in Arizona, the platform was evaluated during NMP of seven human donor livers. Continuous monitoring revealed biochemical patterns and early warning signals that were not fully captured by conventional intermittent testing.

This work reflects the power of integrating bioengineering with clinical transplantation needs. By continuously monitoring both perfusate and bile, we can capture a more complete picture of how a donor liver is functioning during preservation. These real-time data may ultimately help transplant teams make more informed decisions about organ recovery, viability, and acceptance."

Dr. Yangzhi Zhu, Assistant Professor, Terasaki Institute for Biomedical Innovation

The study also suggests that bile-based biochemical signals may provide valuable information beyond perfusion fluid measurements alone. Early analysis indicated that combining bile and perfusate data may improve the ability to interpret post-transplant outcomes, although the researchers emphasize that larger clinical studies will be needed before the platform can be used to guide transplantation decisions.

Beyond liver transplantation, the dual-compartment monitoring strategy may have broader applications in organ preservation, transplant research, and other biomedical systems that require continuous biochemical assessment. Future work will focus on validating the platform in larger patient cohorts, expanding the range of measurable biomarkers, and exploring whether real-time biochemical data can be used to guide adaptive or automated perfusion strategies.

The study highlights the Terasaki Institute's mission to develop practical, clinically relevant technologies at the interface of biosensors, medical devices, and translational medicine.