World's First! First Affiliated Hospital of Sun Yat-sen University Successfully Implements Domino Extracorporeal Liver Treatment

Background

Liver failure, particularly acute-on-chronic liver failure, presents severe challenges with high mortality when standard artificial liver support proves insufficient and complications such as infection create contraindications for immediate transplantation. In China, such cases are common, and organ shortages limit transplant access. The organ transplant team at The First Affiliated Hospital of Sun Yat-sen University, led by Professor He Xiaoshun, director of the hospital's Organ Transplant Center and Sun Yat-sen University Organ Donation Research Institute, has focused on this area. He proposed the concept of extracorporeal liver support in 2021. The team conducted supporting large-animal experiments between 2022 and early 2024 before advancing to clinical application.

What was achieved

On March 3-4, 2025, the hospital announced that Professor He Xiaoshun's team had successfully implemented the world's first domino extracorporeal liver treatment. The patient, referred to as Mr. Chen, had been diagnosed with acute-on-chronic liver failure approximately three months earlier after developing jaundice. Despite multiple sessions of artificial liver therapy, his condition worsened, with bilirubin levels rising. A chest CT later revealed a new cavity indicating pulmonary infection, rendering immediate liver transplantation contraindicated.

The team utilized a functional polycystic liver, weighing approximately 30 jin, which had been excised from another transplant recipient. This liver was maintained ex vivo in a multi-organ preservation system for about five hours, during which parameters such as lactate metabolism and bile production were monitored. It was then connected to Mr. Chen's circulation. The extracorporeal support session lasted 10 hours and 45 minutes. Bilirubin levels decreased from 554.6 μmol/L to 207.6 μmol/L and stabilized below 300 μmol/L. The patient's mental status, appetite, sleep, and physical strength improved significantly. With concurrent anti-infection treatment, the pulmonary infection was controlled, creating conditions for transplantation. On January 24, under Professor He's guidance, Professors Wang Dongping, Guo Zhiyong, and Zhao Qiang successfully performed the liver transplant. Mr. Chen recovered and was discharged after two weeks of postoperative care.

How it works

The domino extracorporeal liver treatment involves using a liver that is diseased in a manner that makes it unsuitable for direct transplantation, such as one affected by polycystic liver disease, yet which retains substantial functional capacity in terms of metabolic activity. This liver is first explanted from its original recipient during their transplant procedure and placed in a specialized ex vivo maintenance system that provides perfusion with oxygenated blood, nutrients, and controlled conditions to keep it viable. During this nurturing phase, typically lasting several hours, medical staff closely observe indicators of liver performance including bile secretion and lactate clearance.

Once function is confirmed, the preserved liver is connected through vascular tubing to the failing patient's bloodstream, often integrating with existing dialysis or similar access points. In this configuration, the external liver acts as a temporary biological support system, performing a broad range of hepatic tasks: clearing toxins such as bilirubin from the blood, synthesizing proteins and coagulation factors, regulating metabolism, and supporting other physiological processes that a failing native liver cannot manage adequately. The patient's own liver remains in place. The 'domino' designation describes the sequential reuse principle, in which livers removed from one transplant recipient can be repurposed to support subsequent patients in a chain-like manner, thereby increasing overall organ utility. In Mr. Chen's case, this bridge therapy stabilized him sufficiently to safely undergo definitive transplantation.

What it means for international patients

The First Affiliated Hospital of Sun Yat-sen University operates International Medical Centers at its Yuexiu and Nansha campuses that serve foreign patients, including those from multiple countries and regions. These facilities offer dedicated consultation rooms, English-language support, bilingual medical records, VIP inpatient options, and partnerships with international insurance providers for services such as consultations, diagnostics, and coordinated care. As a major center for organ transplantation and innovative liver therapies, the hospital's advancements in extracorporeal support and transplantation may be relevant to international patients with complex liver failure.

However, this domino extracorporeal liver treatment represents a novel clinical application reported in one specific case. Availability, eligibility criteria, and suitability for individual patients are not specified in public reports and require direct clinical evaluation, ethical review, and confirmation of current protocols. International patients should contact the hospital's international department directly to inquire about options, undergo assessment, and verify any applicable requirements for liver-related care or transplantation programs.

About the hospital

The First Affiliated Hospital of Sun Yat-sen University is a comprehensive Grade 3A teaching hospital located in Guangzhou, Guangdong Province. Founded in 1910 and affiliated with Sun Yat-sen University, it is one of the major medical institutions in southern China. The hospital is recognized for its organ transplantation program, with the Organ Transplant Center noted for performing liver, kidney, and multi-organ transplants. It has conducted pioneering work in organ medicine, including ischemia-free liver transplantation techniques developed by Professor He Xiaoshun's team.

It maintains national key clinical specialties across more than 30 departments and operates dedicated international patient services through its International Medical Center, which includes facilities for overseas and expatriate patients. The hospital manages a high volume of outpatient and inpatient cases annually and participates in Guangdong Province initiatives as a pilot site for international medical services.