HCC recurrence in liver transplants treated with hypothermic oxygenated machine perfusion: An international matched cohort study
Year: 2026
Type: article
Abstract: Background & Aims Liver transplantation (LT) for hepatocellular carcinoma (HCC) is performed worldwide, with 5-year survival rates of approximately 70%. However, post-transplant HCC recurrence occurs in 15-20% of recipients. We aimed to evaluate, for the first time, long-term recurrence-free survival in a large international cohort of patients undergoing LT for HCC using grafts treated with hypothermic oxygenated machine perfusion (HOPE). Methods This observational post hoc analysis of the multicenter European HOPE-REAL study (NCT05520320) included adult recipients with HCC (N = 599) who received a liver from either a donation after brain death (DBD) or donation after circulatory death (DCD) donor, preserved using HOPE, dual-HOPE (DHOPE), or normothermic regional perfusion followed by HOPE (NRP-HOPE) between 2012 and 2022. Propensity score matching was used to compare outcomes between HCC and non-HCC recipients within the HOPE-REAL cohort, and between HOPE-treated HCC recipients and an external control cohort receiving non-perfused livers (n = 484). Results The overall HCC recurrence rate in the HOPE-REAL cohort was 6.9% (41/599), with no significant difference between DBD and DCD liver transplants (7.1% [25/350] vs. 6.4% [16/249]; p = 0.346). One-, 3-, and 5-year overall survival rates were 92%, 86%, and 81%, while recurrence-free survival rates were 90%, 83%, and 78%, respectively. Five-year overall survival was similar between 347 HOPE-treated HCC recipients (82%) and 347 matched non-HCC recipients (84%) ( p = 0.625). In contrast, compared to an external cohort of 312 non-perfused HCC recipients, 5-year overall survival was significantly higher in 312 matched HOPE-treated HCC recipients (74% vs. 84%; p = 0.034). Conclusions HCC recurrence was rare after transplantation of livers treated with HOPE. Long-term survival in HOPE-treated HCC recipients was significantly better than in those receiving non-perfused livers, and comparable to outcomes in non-HCC recipients. These findings warrant validation in a randomized clinical trial. Impact and implications This post hoc analysis of the HOPE REAL study demonstrates, for the first time, low hepatocellular carcinoma (HCC) recurrence rates in a large cohort of hypothermic oxygenated machine perfusion-treated liver transplant recipients with HCC, and significantly better survival outcomes compared to matched recipients of non-perfused grafts. These findings may have important implications, particularly as tumor-related indications for liver transplantation continue to rise. Machine liver perfusion could emerge as a novel strategy to improve oncological outcomes in high-risk cancer conditions after transplantation, potentially via mitigation of inflammation and reduced tumor cell seeding. Clinical trial number NCT05520320
Source: JHEP Reports
Authors: Janina Eden, Philip C. Müller, Christoph Kuemmerli, Marco Bongini, Francesca Albanesi, Carlo Sposito, Gabriela Berlakovich, Bettina M. Buchholz, Florin Botea, Stefania Camagni, Matteo Cescon, Umberto Cillo, Fabio Colli, Philippe Compagnon, Luciano G. De Carlis, Riccardo De Carlis, Fabrizio Di Benedetto, Jule Dingfelder, Dulce Diogo, Daniele Dondossola, Moritz Drefs, Jiri Fronek, Giuliana Germinario, Enrico Gringeri, Christiano Guidetti, Georg Györi, Matej Kocik, Efrayim H. Küçükerbil, Dionysios Koliogiannis, Hwai-Ding Lam, Georg Lurje, Paolo Magistri, Diethard Monbaliu, Mostafa el Moumni, Beat P. Müller, Damiano Patrono, Wojciech G. Polak, Robert J. Porte, Matteo Ravaioli, Michel Rayar, Renato Romagnoli, Gustaf Sörensen, Deniz Uluk, Pierre A. Clavien, Vincenzo Mazzaferro, Philipp Dutkowski, Vincent E. de Meijer
Institutions: University Medical Center Groningen, University of Groningen, University of Basel, University of Milan, Fondazione IRCCS Istituto Nazionale dei Tumori, Medical University of Vienna, University Medical Center Hamburg-Eppendorf, Titu Maiorescu University, Institutul Clinic Fundeni, Ospedale Papa Giovanni XXIII, University of Bologna, University of Padua, Azienda Ospedale - Università Padova, Azienda Ospedaliera Citta' della Salute e della Scienza di Torino, University of Geneva, Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda, University of Modena and Reggio Emilia, Unidade Local de Saúde de Coimbra, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Ludwig-Maximilians-Universität München, Institute of Clinical and Experimental Medicine, Erasmus MC, Erasmus MC Transplant Institute, Leiden University Medical Center, Heidelberg University, University Hospital Heidelberg, Universitair Ziekenhuis Leuven, Centre Hospitalier Universitaire de Rennes, Sahlgrenska University Hospital, University of Zurich, University Hospital Zurich
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $4,110
Funders: Universität Basel, Università Degli Studi di Modena e Reggio Emila, Università degli Studi di Milano, Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung, Universiteit Leiden, Rijksuniversiteit Groningen, Universität Wien, Leids Universitair Medisch Centrum, Universitair Medisch Centrum Groningen, Sahlgrenska Universitetssjukhuset, Medizinische Universität Wien, Università di Bologna, Université de Genève, Universitätsspital Zürich, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Universitätsklinikum Heidelberg, Centre Hospitalier Universitaire de Rennes, Universitätsklinikum Hamburg-Eppendorf
Award: G5977124818
OpenAlex ID: W7125420498