Liver transplantation (LT) is a key treatment for primary and secondary liver cancers, reducing tumor burden with concurrent improvement of liver function. While significant improvement in survival is noted with LT, cancer recurrence rates remain high. Mitochondrial dysfunction caused by ischemia-reperfusion injury (IRI) is known to drive tumor recurrence by creating a favorable microenvironment rich in pro-inflammatory and angiogenic factors. Therefore, strategies that decrease reperfusion injury and mitochondrial dysfunction may also decrease cancer recurrence following LT. Machine perfusion techniques are increasingly used in routine clinical practice of LT with improved post-transplant outcomes and increased use of marginal grafts. Normothermic (NMP) and hypothermic oxygenated machine perfusion (HOPE) provide oxygen to ischemic tissues, and impact IRI and potential cancer recurrence through different mechanisms. This article discussed the link between IRI-associated inflammation and tumor recurrence after LT. The current literature was screened for the role of machine perfusion as a strategy to mitigate the risk of cancer recurrence. Upfront NMP (“ischemia free organ transplantation”) and end-ischemic HOPE were shown to reduce hepatocellular carcinoma recurrence in retrospective studies. Three prospective randomized controlled trials are ongoing in Europe to provide robust evidence on the impact of HOPE on cancer recurrence in LT.
肝移植是治疗原发性和继发性肝癌的关键手段，通过减轻肿瘤负荷同时改善肝功能实现治疗目标。尽管肝移植显著提高了患者生存率，但肿瘤复发率仍然居高不下。已知缺血再灌注损伤引起的线粒体功能障碍会通过形成富含促炎因子和血管生成因子的有利微环境驱动肿瘤复发。因此，降低再灌注损伤和线粒体功能障碍的策略可能同时减少肝移植后的肿瘤复发。机器灌注技术在肝移植常规临床实践中应用日益广泛，不仅改善了移植后预后，还促进了边缘供肝的使用。常温机械灌注和低温氧合机械灌注通过不同机制为缺血组织供氧，影响缺血再灌注损伤及潜在的肿瘤复发。本文探讨了缺血再灌注相关炎症与肝移植后肿瘤复发之间的关联，系统回顾了当前关于机器灌注作为降低肿瘤复发风险策略的文献研究。回顾性研究表明，前期常温机械灌注（"无缺血器官移植"）和终末低温氧合机械灌注可降低肝细胞癌复发率。目前欧洲正在进行三项前瞻性随机对照试验，旨在为低温氧合机械灌注对肝移植肿瘤复发的影响提供有力证据。
肿瘤(癌症)患者之家