Hypothermic Oxygenated Liver Perfusion (HOPE) Prevents Tumor Recurrence in Liver Transplantation From Donation After Circulatory Death
| Autor: | Shishir Shetty, Paolo Muiesan, Joanne O'Rourke, Marit Kalisvaart, Matteo Mueller, Alessandro Parente, Beat Muellhaupt, Philipp Dutkowski, Tahir Shah, Xavier Muller, John Isaac, Andrea Schlegel, Pierre-Alain Clavien |
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| Rok vydání: | 2020 |
| Předmět: |
Liver perfusion
medicine.medical_specialty business.industry medicine.medical_treatment Urology Milan criteria Liver transplantation medicine.disease Tumor recurrence Transplantation 03 medical and health sciences 0302 clinical medicine 030220 oncology & carcinogenesis Hepatocellular carcinoma Cohort Carcinoma medicine 030211 gastroenterology & hepatology Surgery business |
| Zdroj: | Annals of Surgery. 272:759-765 |
| ISSN: | 1528-1140 0003-4932 |
| DOI: | 10.1097/sla.0000000000004258 |
| Popis: | Objective The aim of this study was to investigate tumor recurrence after liver transplantation for hepatocellular carcinoma (HCC), with and without hypothermic oxygenated liver perfusion (HOPE) before transplantation. Patients and methods We analyzed all liver recipients with HCC, transplanted between January 2012 and September 2019 with donation after circulatory death (DCD) livers after previous end-ischemic HOPE-treatment (n = 70, Center A). Tumor parameters and key confounders were compared to consecutive recipients with HCC, transplanted during the same observation period with an unperfused DBD liver (n = 70). In a next step, we analyzed unperfused DCD (n = 70) and DBD liver recipients (n = 70), transplanted for HCC at an external center (Center B). Results Tumor parameters were not significantly different between HOPE-treated DCD and unperfused DBD liver recipients at Center A. One-third of patients were outside established tumor thresholds, for example, Milan criteria, in both groups. Despite no difference in tumor load, we found a 4-fold higher tumor recurrence rate in unperfused DBD livers (25.7%, 18/70), compared to only 5.7% (n = 4/70) recipients with tumor recurrence in the HOPE-treated DCD cohort (P = 0.002) in Center A. The tumor recurrence rate was also twice higher in unperfused DCD and DBD recipients at the external Center B, despite significant less cases outside Milan. HOPE-treatment of DCD livers resulted therefore in a 5-year tumor-free survival of 92% in HCC recipients, compared to 73%, 82.7%, and 81.2% in patients receiving unperfused DBD or DCD livers, from both centers. Conclusion We suggest that a simple machine liver perfusion approach appears advantageous to protect from HCC recurrence after liver transplantation, despite extended tumor criteria. |
| Databáze: | OpenAIRE |
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