Jia Zehua, Zhu Jiaxing, Zhang Jiayi, Zhang Jian, Huang Changjun, Zhang Niancun, Li Songming, Dong Yuqi, Liu Yao, Zeng Ping, Wang Tielong, Chen Zhitao, Tang Yunhua, Zhao Qiang, Chen Maogen, Chen Yinghua, Hu Anbin, Ju Weiqiang, Ma Yi, Wang Dongping, Zhu Xiaofeng, Schlegel Andrea, Stefan Tullius G, He Xiaoshun, Guo Zhiyong
Organ Transplant Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Guangdong Provincial Key Laboratory of Organ Medicine, Guangzhou, China.
JHEP Rep. 2025 Mar 12;7(7):101393. doi: 10.1016/j.jhepr.2025.101393. eCollection 2025 Jul.
BACKGROUND & AIMS: Ischemia-free liver transplantation (IFLT) is a novel technique designed to avoid ischemia-reperfusion injury (IRI). Here, we report the first detailed 5-year follow-up outcomes.
We conducted a cohort study comparing long-term outcomes between IFLT and conventional liver transplantation (CLT) recipients of livers donated after brain death (DBD). The primary objective was to evaluate 5-year patient and graft survival. Additional endpoints included graft loss, biliary complications, rejection, infections, and liver-related laboratory tests. Subgroup analysis was performed to validate the generalizability of the results in patients with pre-transplant hepatocellular carcinoma (HCC).
A total of 168 patients were enrolled, with 38 patients in the IFLT group and 130 patients in the CLT group. Five-year patient survival (86.84% . 56.92%; hazard ratio [HR] 0.246, 95% confidence interval [CI] 0.098-0.620; <0.01) and graft survival (84.61% . 56.92%; HR 0.307, 95% CI 0.131-0.719; <0.01) rates were significantly improved in the IFLT group compared with the CLT group. In the multivariate analysis, IFLT emerged as an independent protective factor for 5-year patient survival (HR 0.246, 95% CI 0.098-0.620; <0.01). Conversely, HCC before transplantation (HR 2.039, 95% CI 1.159-3.590; <0.05), donor age (HR 1.022, 95% CI 1.001-1.040; <0.05), and extended criteria donor (HR 2.088, 95% CI 1.215-3.590; <0.01) were identified as independent risk factors for impaired 5-year patient survival. In patients with pre-transplant HCC, the 5-year overall survival rate of the IFLT group was also significantly higher than that of the CLT group after adjustment for HCC risk factors (82.35% . 42.03%; HR 0.249, 95% CI 0.074-0.831; <0.05).
Long-term (5-year) follow-up data demonstrate that the use of IFLT potentially improves both patient and graft survival, when compared with CLT, in transplantation of brain-dead donor livers.
Ischemia-free liver transplantation (IFLT) has emerged as a new approach designed to avoid IRI throughout all episodes of the transplant procedure. It has been confirmed that the use of IFLT can substantially reduce early-onset graft IRI-related complications. In this first 5-year follow-up study on the IFLT technique, we demonstrate that, compared with conventional liver transplantation, IFLT can potentially improve long-term patient and graft survival by reducing cancer recurrence. This new technique has the potential to change current clinical practice, particularly in the use of marginal grafts and in patients with HCC.
chictr.org (ChiCTR-OPN-17012090).
无缺血肝移植（IFLT）是一种旨在避免缺血再灌注损伤（IRI）的新技术。在此，我们报告首次详细的5年随访结果。
我们进行了一项队列研究，比较脑死亡后捐赠肝脏的IFLT受者与传统肝移植（CLT）受者的长期结局。主要目的是评估5年患者及移植物存活率。其他终点包括移植物丢失、胆道并发症、排斥反应、感染及肝脏相关实验室检查。进行亚组分析以验证结果在移植前患有肝细胞癌（HCC）患者中的可推广性。
共纳入168例患者，IFLT组38例，CLT组130例。IFLT组的5年患者存活率（86.84%对56.92%；风险比[HR]0.246，95%置信区间[CI]0.098 - 0.620；P<0.01）和移植物存活率（84.61%对56.92%；HR 0.307，95%CI 0.131 - 0.719；P<0.01）与CLT组相比显著提高。在多变量分析中，IFLT是5年患者存活的独立保护因素（HR 0.246，95%CI 0.098 - 0.620；P<0.01）。相反，移植前HCC（HR 2.039，95%CI 1.159 - 3.590；P<0.05）、供体年龄（HR 1.022，95%CI 1.001 - 1.040；P<0.05）和扩大标准供体（HR 2.088，95%CI 1.215 - 3.590；P<0.01）被确定为5年患者存活受损的独立危险因素。在移植前患有HCC的患者中，调整HCC危险因素后，IFLT组的5年总存活率也显著高于CLT组（82.35%对42.03%；HR 0.249，95%CI 0.074 - 0.８31；P<0.05）。
长期（5年）随访数据表明，在脑死亡供体肝脏移植中，与CLT相比，使用IFLT可能提高患者及移植物存活率。
无缺血肝移植（IFLT）已成为一种旨在在移植过程的所有阶段避免IRI的新方法。已证实使用IFLT可大幅减少早期移植物IRI相关并发症。在这项关于IFLT技术的首次5年随访研究中，我们证明，与传统肝移植相比，IFLT可通过减少癌症复发潜在地提高长期患者及移植物存活率。这项新技术有可能改变当前临床实践，特别是在边缘移植物的使用和HCC患者中。
chictr.org（ChiCTR - OPN - 17012090）
