Department of Surgery and Transplantation, Swiss HPB Center, University Hospital Zurich, Switzerland.
The Liver Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK.
Ann Surg. 2020 Nov;272(5):759-765. doi: 10.1097/SLA.0000000000004258.
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.
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).
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.
We suggest that a simple machine liver perfusion approach appears advantageous to protect from HCC recurrence after liver transplantation, despite extended tumor criteria.
本研究旨在探讨肝移植治疗肝细胞癌（HCC）后肿瘤复发的情况，包括移植前采用低温氧合肝脏灌注（HOPE）与未采用该方法的情况。
我们分析了 2012 年 1 月至 2019 年 9 月期间，采用捐赠者循环死亡（DCD）肝脏进行肝移植治疗 HCC 的所有患者，这些患者在移植前均接受过 HOPE 预处理（n=70，中心 A）。我们比较了中心 A 中接受 HOPE 预处理的 DCD 肝脏移植患者与同期接受未灌注 DBD 肝脏移植的 HCC 患者的肿瘤参数和关键混杂因素（n=70）。在下一步中，我们分析了中心 B 中未灌注的 DCD（n=70）和 DBD 肝脏移植患者（n=70）的情况，这些患者接受 HCC 肝移植的中心为外部中心。
HOPE 预处理的 DCD 与未灌注的 DBD 肝脏移植患者的肿瘤参数在中心 A 中无显著差异。两组患者中均有三分之一的患者超出了米兰标准等既定的肿瘤标准。尽管肿瘤负荷无差异，但我们发现未灌注的 DBD 肝脏中肿瘤复发率高 4 倍（25.7%，18/70），而 HOPE 预处理的 DCD 队列中仅有 5.7%（n=4/70）的患者发生肿瘤复发（P=0.002）。在外部中心 B 中，未灌注的 DCD 和 DBD 肝脏受体的肿瘤复发率也高出两倍，尽管米兰标准外的病例明显减少。因此，HOPE 预处理 DCD 肝脏可使 HCC 患者的 5 年无肿瘤生存率达到 92%，而中心 A 和 B 中未灌注的 DBD 或 DCD 肝脏受体的 5 年无肿瘤生存率分别为 73%、82.7%和 81.2%。
我们建议，尽管扩大了肿瘤标准，但采用简单的机器肝脏灌注方法似乎有利于防止肝移植后 HCC 复发。
