Shu Wenzhi, Chen Hao, Wang Ruolin, Song Jiyong, Tang Rui, Wu Guangdong, Yu Lihan, Tong Xuan, Wang Xiaojuan, Hou Yucheng, Zhao Wen Long, Zhu Lizhen, Yan Jun, Lu Qian
Hepatopancreatobiliary Center, Organ Transplantation Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; School of Clinical Medicine, Tsinghua University, Beijing, China; Institute for Intelligent Healthcare, Tsinghua University, Beijing, China; Key Laboratory of Digital Intelligence Hepatology (Chinese Ministry of Education), School of Clinical Medicine, Tsinghua University, Beijing, China; Institute for Organ Transplantation and Bionics, Institute for Precision Medicine of School of Clinical Medicine, Tsinghua University, Beijing, China.
Hepatopancreatobiliary Center, Organ Transplantation Center, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing, China; School of Clinical Medicine, Tsinghua University, Beijing, China; Key Laboratory of Digital Intelligence Hepatology (Chinese Ministry of Education), School of Clinical Medicine, Tsinghua University, Beijing, China; Institute for Organ Transplantation and Bionics, Institute for Precision Medicine of School of Clinical Medicine, Tsinghua University, Beijing, China.
Cancer Lett. 2025 Aug 7;633:217970. doi: 10.1016/j.canlet.2025.217970.
There is controversy regarding whether the machine perfusion (MP) prevents hepatocellular carcinoma (HCC) recurrence after liver transplantation (LT). This study aimed to explore the impact of MP on HCC recurrence. We included data from the United Network for Organ Sharing (UNOS) database on HCC patients spanning from April 2015 and January 2024. Patients who received MP-preserved donor were propensity score-matched (PSM) 1:1 with those who received static cold storage (SCS)-preserved donor. The primary outcome was recurrence-free survival (RFS) rate. Cox regression models were used to identify predictors of RFS. Subgroup analyses assessed the role of MP across various groups and to identify the beneficial group. The PSM cohort comprised 411 HCC recipients with MP-preserved donors and 411 with SCS-preserved donors. The 2-year RFS rate was significantly higher in the MP group compared to the SCS group (96.5 % vs. 89.7 %, P = 0.008). Univariate and multivariate Cox regression analyses revealed that MP preservation method was an independent predictor of RFS [adjusted hazard ratio (aHR), 0.158; 95 % confidence interval (CI), 0.048-0.523; P = 0.003]. In the beneficial group, defined by the cumulative of MP-enhancing factors, MP improved RFS comparable to SCS group (96.7 % vs. 76.2 %, P = 0.001). MP effectively prevents HCC recurrence post-LT. MP should be used more proactively in the beneficial groups, including those with hemodynamically unstable donors and high tumor burden, to improve the survival outcomes.
关于机器灌注（MP）能否预防肝移植（LT）后肝细胞癌（HCC）复发存在争议。本研究旨在探讨MP对HCC复发的影响。我们纳入了器官共享联合网络（UNOS）数据库中2015年4月至2024年1月期间HCC患者的数据。接受MP保存供体的患者与接受静态冷藏（SCS）保存供体的患者按倾向得分匹配（PSM），比例为1:1。主要结局是无复发生存（RFS）率。使用Cox回归模型确定RFS的预测因素。亚组分析评估了MP在不同组中的作用，并确定受益组。PSM队列包括411例接受MP保存供体的HCC受者和411例接受SCS保存供体的受者。MP组的2年RFS率显著高于SCS组（96.5%对89.7%，P = 0.008）。单因素和多因素Cox回归分析显示，MP保存方法是RFS的独立预测因素[调整后风险比（aHR），0.158；95%置信区间（CI），0.048 - 0.523；P = 0.003]。在由MP增强因素累积定义的受益组中，MP改善RFS的效果与SCS组相当（96.7%对76.2%，P = 0.001）。MP可有效预防LT后HCC复发。应在受益组中更积极地使用MP，包括那些供体血流动力学不稳定和肿瘤负荷高的患者，以改善生存结局。
