Machine Perfusion as a Strategy to Decrease Ischemia-Reperfusion Injury and Lower Cancer Recurrence Following Liver...

Area of Science:

• Hepatobiliary surgery
• Transplant immunology
• Oncology

Background:

• Liver transplantation (LT) is crucial for liver cancer, yet cancer recurrence is a significant challenge.
• Ischemia-reperfusion injury (IRI) exacerbates inflammation and mitochondrial dysfunction, promoting tumor recurrence post-LT.
• Machine perfusion (MP) is emerging as a method to improve organ quality and outcomes in LT.

Purpose of the Study:

• To explore the link between IRI-induced inflammation and cancer recurrence after LT.
• To evaluate machine perfusion strategies, specifically NMP and HOPE, in mitigating cancer recurrence risk.
• To review current literature and ongoing trials on MP's role in reducing post-LT cancer recurrence.

Main Methods:

• Literature screening focused on IRI, inflammation, and cancer recurrence in LT.
• Analysis of machine perfusion techniques (NMP, HOPE) and their impact on IRI.
• Review of retrospective and prospective studies on MP for reducing hepatocellular carcinoma recurrence.

Main Results:

• IRI creates a pro-inflammatory microenvironment that favors tumor recurrence.
• Retrospective studies suggest upfront NMP and end-ischemic HOPE reduce hepatocellular carcinoma recurrence.
• Three prospective randomized controlled trials are underway to validate HOPE's efficacy.

Conclusions:

• Reducing IRI and mitochondrial dysfunction via MP may decrease cancer recurrence after LT.
• NMP and HOPE show promise in mitigating IRI and improving outcomes in LT for cancer patients.
• Further robust evidence from ongoing trials is needed to confirm the benefits of MP in reducing LT cancer recurrence.