Preventing Tumour Recurrence after Liver Transplantation: The Role of Machine Perfusion

Boteon, Yuri L.; Carvalho, Mauricio Flores; Panconesi, Rebecca; Muiesan, Paolo; Schlegel, Andrea

doi:10.3390/ijms21165791

Cited by 12 publications

(7 citation statements)

References 116 publications

(200 reference statements)

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“…Further studies assessing the impact of CIT on HCC recurrence support the recently presented mechanistical link between ischemia-reperfusion injury and later HCC recurrence, which point to a possible higher risk for HCC recurrence when livers from extended criteria donors (ECDs), including DCDs, are used. 32,34,99,105 Nagai et al demonstrated higher HCC recurrence rates in LT with prolonged CIT. 106,107 The perfect environment needed for cancer cells to invade and regrow includes most features of ischemia-reperfusion injury with a general inflammation in the new graft and recipient body.…”

Section: Recipient Underlying Diseasementioning

confidence: 99%

Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation

et al. 2021

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Although the utilization of donation after circulatory death donors (DCDs) for liver transplantation (LT) has increased steadily, much controversy remains, and no common acceptance criteria exist with regard to donor and recipient risk factors and prediction models. A consensus conference was organized by International Liver Transplantation Society on January 31, 2020, in Venice, Italy, to review the current clinical practice worldwide regarding DCD-LT and to develop internationally accepted guidelines. The format of the conference was based on the grade system. International experts in this field were allocated to 6 working groups and prepared evidence-based recommendations to answer-specific questions considering the currently available literature. Working group members and conference attendees served as jury to edit and confirm the final recommendations presented at the end of the conference by each working group separately. This report presents the final statements and recommendations provided by working group 2, covering the entire spectrum of donor and recipient risk factors and prediction models in DCD-LT.

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Section: Recipient Underlying Diseasementioning

confidence: 99%

Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation

et al. 2021

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“…While LT for CCA remains controversial, oncological, targeted therapies and promising prospects of improved oncological outcomes by, e.g., machine perfusion of grafts, may explore new pathways [ 48 , 49 ].…”

Section: Discussionmentioning

confidence: 99%

The Role of Immunosuppression for Recurrent Cholangiocellular Carcinoma after Liver Transplantation

Gül‐Klein

Schmitz

Schöning

et al. 2022

Cancers

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Liver transplantation (LT) for cholangiocarcinoma (CCA), or biliary tract cancer (BTC), remains controversial regarding high recurrence rates and poor prognosis. Oncological follow-up may benefit from tumor-inhibiting properties of mTOR inhibitors (mTORI), shown with improved survival for recurrent hepatocellular carcinoma (HCC) patients after LT. The aim of this study was to investigate the recurrence and survival in relation to tumor type and type of immunosuppression (IS). LT patients with CCA or mixed HCC/CCA (mHCC/CCA) (n = 67) were retrospectively analyzed. Endpoints were the time from LT to recurrence (n = 44) and survival after recurrence. Statistically significant impairment in survival for recurrent CCA (rCCA) was shown in patients not eligible for surgical resection (HR 2.46 (CI: 1.2–5.1; p = 0.02). Histological proven grading >1 and N1 status at initial transplantation were associated with impaired survival (HR 0.13 (CI: 0.03–0.58); p < 0.01 and HR 3.4 (CI: 1.0–11.65); p = 0.05). Reduced IS after tumor recurrence improved survival (HR 4.2/CI: 1.3–13.6; p = 0.02). MTORI initiation before recurrence or after had no significant impact on survival. Our data thereby indicate, similar to findings in recurrent HCC after LT, that patients with rCCA after LT benefit from a reduction in IS upon recurrence.

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“…Ongoing inflammation in the transplanted liver and the entire recipient body may lead to graft loss due to ischemic cholangiopathy (IC) and recurrence of hepatocellular carcinoma (HCC), particularly when cells have lost their ability to metabolically resolve the ongoing inflammation [37][38][39][40][41].…”

Section: Key Pointsmentioning

confidence: 99%

Liver perfusion strategies: what is best and do ischemia times still matter?

Panconesi

Carvalho

Muiesan

et al. 2022

Current Opinion in Organ Transplantation

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Purpose of reviewThis review describes recent developments in the field of liver perfusion techniques.Recent findingsDynamic preservation techniques are increasingly tested due to the urgent need to improve the overall poor donor utilization. With their exposure to warm ischemia, livers from donors after circulatory death (DCD) transmit additional risk for severe complications after transplantation. Although the superiority of dynamic approaches compared to static-cold-storage is widely accepted, the number of good quality studies remains limited. Most risk factors, particularly donor warm ischemia, and accepted thresholds are inconsistently reported, leading to difficulties to assess the impact of new preservation technologies. Normothermic regional perfusion (NRP) leads to good outcomes after DCD liver transplantation, with however short ischemia times. While randomized controlled trials (RCT) with NRP are lacking, results from the first RCTs with ex-situ perfusion were reported. Hypothermic oxygenated perfusion was shown to protect DCD liver recipients from ischemic cholangiopathy. In contrast, endischemic normothermic perfusion seems to not impact on the development of biliary complications, although this evidence is only available from retrospective studies.SummaryDynamic perfusion strategies impact posttransplant outcomes and are increasingly commissioned in various countries along with more evidence from RCTs. Transparent reporting of risk and utilization with uniform definitions is required to compare the role of different preservation strategies in DCD livers with prolonged ischemia times.

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Preventing Tumour Recurrence after Liver Transplantation: The Role of Machine Perfusion

Cited by 12 publications

References 116 publications

Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation

Recommendations for Donor and Recipient Selection and Risk Prediction: Working Group Report From the ILTS Consensus Conference in DCD Liver Transplantation

The Role of Immunosuppression for Recurrent Cholangiocellular Carcinoma after Liver Transplantation

Liver perfusion strategies: what is best and do ischemia times still matter?

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