Hypothermic Oxygenated Liver Perfusion (HOPE) Prevents Tumor Recurrence in Liver Transplantation From Donation After Circulatory Death. Issue 5 (November 2020)

• Record Type: Journal Article
• Authors: Mueller, Matteo; Kalisvaart, Marit; O'Rourke, Joanne; Shetty, Shishir; Parente, Alessandro; Muller, Xavier; Isaac, John; Muellhaupt, Beat; Muiesan, Paolo; Shah, Tahir; Clavien, Pierre-Alain; Schlegel, Andrea; Dutkowski, Philipp
• Is Part Of: Annals of surgery. Volume 272:Issue 5(2020)
• Publication Date: 2020-11
• Subjects: hypothermic oxygenated perfusion -- hepatocellular carcinoma -- tumor recurrence -- liver transplantation; Surgery -- Periodicals; 617.005
• DOI: 10.1097/SLA.0000000000004258
• Languages: English
• ISSNs: 0003-4932

Abstract

Abstract : 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. Abstract : Supplemental Digital Content is available in the text