Impact of Normothermic Machine Perfusion on Access to Liver Transplantation in Patients With Primary Hepatic Malignancies

作者：Dominic Amara, Andrew Melehy, Samer Ebaid, Fady M. Kaldas, Douglas G. Farmer, Peter G. Stock, Alex Bui, Neil Mehta, Vatche G. Agopian · 发表于：Clinical Transplantation · 年份：2025 · DOI：10.1111/ctr.70254 · 被引用次数：3 · 研究领域：Organ Transplantation Techniques and Outcomes、Hepatocellular Carcinoma Treatment and Prognosis、Liver Disease and Transplantation

BACKGROUND: Balancing the probability of transplant and waitlist dropout in patients with hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) using MELD exception points has been an enduring challenge. The advent of normothermic machine perfusion (NMP) has the potential to increase access to transplantation in patients with primary hepatic malignancies. METHODS: Using the Scientific Registry of Transplant Recipients database, this study evaluated the impact of widespread availability of NMP on access to liver transplantation in transplant oncology. Waitlist outcomes and transplant characteristics between patients with HCC and CCA after the implementation of acuity circles but before the widespread NMP availability (pre-NMP era, February 2020 to September 2021) were compared to those after widespread NMP availability (NMP era, September 2021 to September 2023) based on waitlist date. RESULTS: A total of 7564 patients with HCC (3691 pre-NMP; 3874 NMP era) and 354 patients with CCA (193 pre-NMP; 161 NMP era) were waitlisted over the study period. NMP-era patients had a higher probability of transplant at 1 year from listing for both HCC (59% vs. 49%, p < 0.001) and CCA (71% vs. 56%, p = 0.012). Patients with HCC also had a lower risk of death or waitlist dropout (14% vs. 16% at 1 year, p = 0.016). After adjustment for other factors affecting probability of transplant in HCC, the NMP era (aSHR 1.26, 95% CI 1.18-1.34, p < 0.001) and transplantation at a high-volume NMP cen...