Continuous biochemical monitoring of both perfusion fluid and bile may improve assessment of donor livers before transplantation, according to new research describing a point-of-care monitoring platform tested in human donor organs.
The system was designed to address a longstanding limitation of normothermic machine perfusion, in which laboratory measurements are typically performed every 30–60 minutes. Instead, the new platform continuously measures pH, glucose, and lactate in both the circulating perfusion fluid and bile, transmitting results wirelessly without interrupting the preservation process.
In a study published in Nature Communications, researchers evaluated the technology during machine perfusion of seven human donor livers. Measurements closely matched those generated by standard clinical analyzers, while also detecting short-lived biochemical changes that routine intermittent sampling missed. In one liver that was ultimately discarded, rising bile lactate was observed before conventional indicators suggested deteriorating graft function, highlighting the potential value of continuous monitoring for earlier recognition of unfavorable trends.
An important feature is the simultaneous analysis of two biological compartments. Current assessment strategies rely primarily on perfusion fluid, but bile contains additional information about the health of the bile ducts, a major determinant of transplant success. By integrating measurements from both fluids, the system provides a broader biochemical picture than perfusate testing alone.
The authors also explored whether continuously collected measurements could be combined into composite features associated with early transplant outcomes. Although several bile-derived measures appeared more informative than perfusate markers alone, the investigators emphasize that these analyses were exploratory and should not be used for clinical decision-making.
The study's small sample size and limited follow-up mean larger prospective studies will be needed before the approach can influence transplant practice. Even so, the work demonstrates that continuous, workflow-compatible biochemical monitoring is technically feasible and could help shift diagnostics from isolated laboratory snapshots toward longitudinal assessment, potentially enabling future decision-support tools for organ preservation and transplantation.
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