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HCC recurrence in liver transplants treated with hypothermic oxygenated machine perfusion: an international matched cohort study

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 s...

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Main Authors: Eden, Janina (Author) , Müller, Philip C. (Author) , Kuemmerli, Christoph (Author) , Bongini, Marco (Author) , Albanesi, Francesca (Author) , Sposito, Carlo (Author) , Berlakovich, Gabriela (Author) , Buchholz, Bettina M. (Author) , Botea, Florin (Author) , Camagni, Stefania (Author) , Cescon, Matteo (Author) , Cillo, Umberto (Author) , Colli, Fabio (Author) , Compagnon, Philippe (Author) , De Carlis, Luciano G. (Author) , De Carlis, Riccardo (Author) , Di Benedetto, Fabrizio (Author) , Dingfelder, Jule (Author) , Diogo, Dulce (Author) , Dondossola, Daniele (Author) , Drefs, Moritz (Author) , Fronek, Jiri (Author) , Germinario, Giuliana (Author) , Gringeri, Enrico (Author) , Guidetti, Christiano (Author) , Györi, Georg (Author) , Kocik, Matej (Author) , Küçükerbil, Efrayim H. (Author) , Koliogiannis, Dionysios (Author) , Lam, Hwai-Ding (Author) , Lurje, Georg (Author) , Magistri, Paolo (Author) , Monbaliu, Diethard (Author) , Moumni, Mostafa el (Author) , Müller, Beat P. (Author) , Patrono, Damiano (Author) , Polak, Wojciech G. (Author) , Porte, Robert J. (Author) , Ravaioli, Matteo (Author) , Rayar, Michel (Author) , Romagnoli, Renato (Author) , Sörensen, Gustaf (Author) , Uluk, Deniz (Author) , Clavien, Pierre A. (Author) , Mazzaferro, Vincenzo (Author) , Dutkowski, Philipp (Author) , de Meijer, Vincent E. (Author)
Format: Article (Journal)
Language:English
Published: March 2026
In: JHEP reports
Year: 2026, Volume: 8, Issue: 3, Pages: 1-10
ISSN:2589-5559
DOI:10.1016/j.jhepr.2026.101732
Online Access:Verlag, kostenfrei, Volltext: https://doi.org/10.1016/j.jhepr.2026.101732
Verlag, kostenfrei, Volltext: https://www.sciencedirect.com/science/article/pii/S2589555926000029
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Author Notes: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
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Summary: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
Item Description:Online verfügbar: 21. Januar 2026, Artikelversion: 17. Februar 2026
Gesehen am 16.04.2026
Physical Description:Online Resource
ISSN:2589-5559
DOI:10.1016/j.jhepr.2026.101732

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