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Machine Perfusion & Organ Preservation
How donor livers can be preserved, supported and assessed outside the body before transplantation.
Liver.lk
Prof. Thamara Perera
Research & Innovation
Liver Transplant & HPB Research
Prof. Thamara Perera's published research spans liver transplantation, machine perfusion, donor organ preservation, portal vein thrombosis, transplant immunology and complex HPB surgery. Explore selected studies, the clinical questions behind them, and how this work has contributed to the wider understanding of complex liver and transplant care.
Research with clinical relevance
Understanding what happens before, during and after a complex liver transplant.
Prof. Perera's selected research explores how donor livers are preserved and assessed, how complex vascular disease can affect transplantation, and how the immune system influences long-term transplant care.
Machine PerfusionDonor organ preservation and assessment
Complex Transplant SurgeryPortal vein disease, graft viability and transplant planning
Research focus
Research around some of the hardest questions in liver transplantation
Prof. Perera's selected publications cover different stages of the transplant journey — from assessing a donor organ, to preserving it, to managing complex disease in the recipient.
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Donor Liver Viability
How transplant teams can gather more information about whether a donor liver may be suitable for transplantation.
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Complex Portal Vein Disease
Research and specialist discussion around portal vein thrombosis in cirrhosis and liver transplantation.
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Transplant Immunology
Understanding immune regulation, rejection and emerging cellular approaches in liver disease and transplantation.
Research experience
Research shaped by complex transplant practice
Prof. Perera's research has developed alongside his clinical work in liver transplantation and hepatobiliary-pancreatic surgery.
From complex transplant surgery to questions that shaped new research
During his time in Birmingham, Prof. Thamara Perera was part of the team behind the first reported human liver transplant using a marginal donor liver resuscitated with normothermic machine perfusion following an initial period of cold storage.
His wider research spans liver transplantation, donor organ preservation, machine perfusion, complex portal vein disease, transplant immunology and HPB surgery.
The selected work on this page explains the clinical questions behind those publications — from how donor livers can be assessed before transplantation to how complex vascular disease can influence transplant planning.
175
Published research papers
9,800+
Research citations
39
h-index
Featured research
Keeping a donor liver functioning while it is assessed
A recurring theme in Prof. Perera's research is machine perfusion — technology that allows a donor liver to be perfused outside the body rather than relying only on conventional cold storage.
Clinical research · Liver transplantation
Nature · 2018
A randomized trial of normothermic preservation in liver transplantation
Machine perfusion can support preservation and allow transplant teams to observe a donor liver outside the body before transplantation.
View the research on PubMed →
What was the research looking at?
The trial compared normothermic machine preservation with conventional cold storage in liver transplantation. The aim was to understand whether keeping donor livers functioning at near-body temperature during preservation could reduce injury and provide more opportunity to assess the organ before transplantation.
What did the study report?
In a randomised trial involving 220 liver transplants, the researchers reported lower biochemical evidence of graft injury, a lower rate of organ discard and a longer average preservation time with normothermic preservation. The study did not report a significant difference in patient or graft survival during the study period.
Why is this important?
Donor organs are limited. Research into preservation and assessment gives transplant teams more information when deciding whether a liver may be suitable for transplantation.
Research stories
The questions behind the publications
Research becomes more meaningful when the clinical question is clear. These studies explore how transplant teams assess donor livers, how long they can be evaluated, how complex vascular disease affects transplantation and how the immune system shapes long-term transplant care.
Nature Communications · 2020 · Clinical Trial
Can some donor livers that were previously declined be reassessed?
The VITTAL trial used normothermic machine perfusion to assess 31 donor livers that had been discarded by UK transplant centres under defined high-risk criteria.
Twenty-two met the trial's viability criteria and were transplanted. The study reported 100% patient and graft survival at 90 days in this study group, while also reporting later biliary complications in some recipients.
Why it matters: The study explored whether objective assessment during perfusion could provide additional information about donor organs that had already been declined.
View on PubMed →Liver Transplantation · 2022
How long should a donor liver be observed during viability assessment?
This publication examined lactate clearance during normothermic machine perfusion of deceased donor liver grafts and reported that the assessment window for the study's lactate threshold could be extended to six hours.
Why it matters: Viability assessment depends on measurable criteria that can help transplant teams make more informed decisions.
View on PubMed →Current Opinion in Organ Transplantation · 2021 · Review
What have we learned about machine preservation?
This review examined recent research on normothermic and hypothermic machine perfusion, including organ viability assessment, graft preservation and the strengths and limitations of different perfusion strategies.
Why it matters: Different perfusion approaches may have different roles depending on the donor organ, the transplant programme and the clinical situation.
View on PubMed →Frontiers in Immunology · 2021 · Review
Can the immune response in liver disease and transplantation be regulated differently?
This review explored regulatory T cells — immune cells involved in controlling immune responses — and their potential relevance to chronic liver disease, transplant tolerance and future cell-based therapies.
Why it matters: Liver transplantation is not only a surgical challenge. Long-term care also depends on how the immune system responds to the transplanted organ.
View on PubMed →
Selected publications
Research across transplantation, preservation and complex liver disease
A curated selection of Prof. Perera's published work is listed below. Each link opens the corresponding PubMed record.
A randomized trial of normothermic preservation in liver transplantation
PubMed →Transplantation of discarded livers following viability testing with normothermic machine perfusion
PubMed →Ex-situ liver preservation with machine preservation
PubMed →Hypothermic Machine Perfusion in Liver Transplantation
PubMed →Portal vein thrombosis in cirrhosis: Controversies and latest developments
PubMed →Regulatory T-Cell Therapy in Liver Transplantation and Chronic Liver Disease
PubMed →Reconstruction for complex portal vein thrombosis - Anatomical if possible
PubMed →Liver graft outcomes from donors with vaccine induced thrombosis and thrombocytopenia (VITT): United Kingdom multicenter experience
PubMed →Assessment of Deceased Brain Dead Donor Liver Grafts via Normothermic Machine Perfusion: Lactate Clearance Time Threshold Can Be Safely Extended to 6 Hours
PubMed →
Research explained
Three ideas worth understanding
Some of the terminology around transplantation can sound highly technical. These concepts are central to understanding why this research matters.
What is machine perfusion in liver transplantation?
Machine perfusion circulates fluid through a donor liver outside the body. Depending on the technique, this can support preservation and allow transplant teams to observe aspects of how the organ is functioning before transplantation.
Why would a donor liver need viability assessment?
Donor livers vary in quality and risk. Viability assessment aims to give the transplant team additional objective information when deciding whether a particular organ may be suitable for a particular recipient.
Why is portal vein thrombosis important in liver care?
The portal vein carries blood into the liver. A clot in this vein can occur in people with cirrhosis and can make treatment or transplantation more complex. Management depends on the extent of thrombosis and the patient's overall condition.
Looking for a Specialist Opinion?
If you have been diagnosed with a complex liver, pancreatic, bile duct or gallbladder condition — or have been advised to consider surgery or liver transplantation — a specialist consultation can help you understand the options available.