常温机器灌注对原发性肝脏恶性肿瘤患者肝移植可及性的影响

Impact of Normothermic Machine Perfusion on Access to Liver Transplantation in Patients With Primary Hepatic Malignancies.

作者信息

Amara Dominic, Melehy Andrew, Ebaid Samer, Kaldas Fady M, Farmer Douglas G, Stock Peter, Bui Alex A T, Mehta Neil, Agopian Vatche G

机构信息

Department of Surgery, Dumont-UCLA Transplant and Liver Cancer Centers, David Geffen School of Medicine at University of California, Los Angeles, California, USA.

Department of Surgery, University of California, San Francisco, California, USA.

出版信息

Clin Transplant. 2025 Aug;39(8):e70254. doi: 10.1111/ctr.70254.

DOI:10.1111/ctr.70254

PMID:40698561

Abstract

BACKGROUND

Balancing the probability of transplant and waitlist dropout in patients with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) using MELD exception points has been an enduring challenge. The advent of normothermic machine perfusion (NMP) has the potential to increase access to transplantation in patients with primary hepatic malignancies.

METHODS

Using the Scientific Registry of Transplant Recipients database, this study evaluated the impact of widespread availability of NMP on access to liver transplantation in transplant oncology. Waitlist outcomes and transplant characteristics between patients with HCC and CCA after the implementation of acuity circles but before the widespread NMP availability (pre-NMP era, February 2020 to September 2021) were compared to those after widespread NMP availability (NMP era, September 2021 to September 2023) based on waitlist date.

RESULTS

A total of 7564 patients with HCC (3691 pre-NMP; 3874 NMP era) and 354 patients with CCA (193 pre-NMP; 161 NMP era) were waitlisted over the study period. NMP-era patients had a higher probability of transplant at 1 year from listing for both HCC (59% vs. 49%, p < 0.001) and CCA (71% vs. 56%, p = 0.012). Patients with HCC also had a lower risk of death or waitlist dropout (14% vs. 16% at 1 year, p = 0.016). After adjustment for other factors affecting probability of transplant in HCC, the NMP era (aSHR 1.26, 95% CI 1.18-1.34, p < 0.001) and transplantation at a high-volume NMP center (aSHR 1.13, 95% CI 1.05-1.22, p = 0.002) were both still associated with higher transplant probability.

CONCLUSIONS

NMP has promise in improving access to liver transplantation for oncologic indications.

摘要

背景

利用终末期肝病模型（MELD）例外点数来平衡肝细胞癌（HCC）和胆管癌（CCA）患者的移植概率与等待名单退出率一直是一项长期挑战。常温机器灌注（NMP）的出现有可能增加原发性肝脏恶性肿瘤患者获得移植的机会。

方法

本研究使用移植受者科学注册数据库，评估NMP广泛应用对移植肿瘤学中肝移植可及性的影响。根据等待名单日期，比较在实施 acuity circles 后但在NMP广泛应用之前（NMP前时代，2020年2月至2021年9月）与NMP广泛应用之后（NMP时代，2021年9月至2023年9月）HCC和CCA患者的等待名单结果及移植特征。

结果

在研究期间，共有7564例HCC患者（NMP前时代3691例；NMP时代3874例）和354例CCA患者（NMP前时代193例；NMP时代161例）被列入等待名单。NMP时代的患者在列入名单后1年接受移植的概率更高，HCC患者（59%对49%，p<0.001）和CCA患者（71%对56%，p = 0.012）均如此。HCC患者死亡或退出等待名单的风险也更低（1年时为14%对16%，p = 0.016）。在对影响HCC患者移植概率的其他因素进行调整后，NMP时代（调整后风险比1.26，95%置信区间1.18 - 1.34，p<0.001）和在高容量NMP中心进行移植（调整后风险比1.13，95%置信区间1.05 - 1.22，p = 0.002）仍与更高的移植概率相关。