Machine perfusion prevents early tumor recurrence in liver transplantation for hepatocellular carcinoma: a multicenter retrospective cohort study

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.