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

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-07-23 DOI:10.1111/ctr.70254

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

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引用次数: 0

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.

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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

背景：利用MELD异常点平衡肝细胞癌（HCC）和胆管癌（CCA）患者的移植和候补名单退出的概率一直是一个长期的挑战。常温机器灌注（NMP）的出现有可能增加原发性肝恶性肿瘤患者的移植机会。方法利用移植受者科学登记数据库，本研究评估了广泛使用NMP对移植肿瘤学中肝移植可及性的影响。基于等待名单日期，将实施视差圈但在NMP广泛可用之前（NMP前时代，2020年2月至2021年9月）的HCC和CCA患者的等待名单结果和移植特征与NMP广泛可用之后（NMP时代，2021年9月至2023年9月）的患者进行比较。结果共7564例HCC患者(nmp前3691例；3874例NMP患者)和354例CCA患者(NMP前193例；在研究期间，161名NMP患者被列入候补名单。nmp时代的患者在两种HCC上市后1年移植的可能性更高(59% vs. 49%, p <；0.001)和CCA（71%对56%，p = 0.012）。HCC患者的死亡或退出等候名单的风险也较低（1年时为14%比16%，p = 0.016）。在校正影响肝癌移植概率的其他因素后，NMP时代(aSHR 1.26, 95% CI 1.18-1.34, p <；0.001)和在大容量NMP中心移植（aSHR 1.13, 95% CI 1.05-1.22, p = 0.002）仍然与较高的移植概率相关。结论NMP有望改善肿瘤指征肝移植的可及性。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.