Machine Perfusion and Oncologic Outcomes After Liver Transplantation for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.
- 1Organ Transplantation Center, National Cancer Center, Korea, 323 Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Gyeonggi-do, Republic of Korea.
Abstract
Background
Machine perfusion has emerged as a promising strategy to attenuate ischemia-reperfusion injury during liver transplantation (LT). However, its impact on hepatocellular carcinoma (HCC) recurrence and post-transplant oncologic outcomes remains uncertain. We performed a systematic review and meta-analysis evaluating the association between machine perfusion and oncologic outcomes after LT for HCC.Methods
A systematic literature search of PubMed/MEDLINE, Embase, and Web of Science was conducted from database inception to May 2026. Comparative clinical studies evaluating machine perfusion and oncologic outcomes after LT for HCC were included. The primary outcome was recurrence-free survival (RFS). Secondary outcomes included HCC recurrence, early recurrence, overall survival (OS), and graft-related outcomes. Risk of bias was assessed using the ROBINS-I tool. Random-effects meta-analyses were performed when appropriate.Results
Six comparative clinical studies involving HCC recipients undergoing LT were included. All studies were observational, and no randomized controlled trial was identified. Three studies were judged to have a moderate risk of bias and three were judged to have a serious risk of bias. In the primary RFS meta-analysis, machine perfusion was associated with a numerically lower risk of recurrence or death, although the pooled estimate did not reach statistical significance (HR 0.34, 95% CI 0.07-1.77; p = 0.20). The binary recurrence analysis also demonstrated a numerically lower risk of HCC recurrence after machine perfusion (RR 0.40, 95% CI 0.13-1.20; p = 0.10). Several studies reported favorable associations between machine perfusion and early recurrence, while large adjusted cohorts reported associations with improved RFS and OS. Machine perfusion was generally associated with lower markers of ischemia-reperfusion injury, including postoperative aminotransferase release.Conclusions
Current evidence suggests a potential favorable association between machine perfusion and oncologic outcomes after LT for HCC. However, the pooled estimates from the primary analyses were not statistically significant, and the evidence remains limited by the small number of studies, observational designs, heterogeneity, and potential cohort overlap. Further prospective studies are required before an oncologic benefit of machine perfusion can be established.
Related
- Post-transplant oncologic outcomes after locoregional downstaging before living donor liver transplantation for hepatocellular carcinoma beyond Milan criteria: a systematic review and meta-analysis of selected cohorts
- Early Prognostic Value of the Freiburg Index of Post-Transjugular Intrahepatic Portosystemic Shunt Survival in Patients With Hepatocellular Carcinoma Undergoing Liver Transplantation
- Perfusion and neuro-functional evaluation of new methods for protection from ischemia–reperfusion injury in microvascular reconstructive post-oncologic surgery
- Beyond Morphology: Pretransplant Tumor-to-Liver FDG Uptake Ratio Predicts Hepatocellular Carcinoma Recurrence After Liver Transplantation
- Pretransplant plasma soluble PD-1 and recurrence after liver transplantation in ICI-treated hepatocellular carcinoma: an exploratory biomarker study
BibTeX
@article{kim2026machine,
title = {{Machine Perfusion and Oncologic Outcomes After Liver Transplantation for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.}},
author = {Seoung Hoon Kim and Byeong Ho An and Jin A Lee and Go Woon Jeong},
journal = {Current oncology (Toronto, Ont.)},
year = {2026},
month = sep,
doi = {10.3390/curroncol33100578},
url = {https://europepmc.org/article/MED/42930145},
note = {CC BY},
}
RIS
TY - JOUR
TI - Machine Perfusion and Oncologic Outcomes After Liver Transplantation for Hepatocellular Carcinoma: A Systematic Review and Meta-Analysis.
AU - Seoung Hoon Kim
AU - Byeong Ho An
AU - Jin A Lee
AU - Go Woon Jeong
PY - 2026
DA - 2026/09/25
JO - Current oncology (Toronto, Ont.)
DO - 10.3390/curroncol33100578
UR - https://europepmc.org/article/MED/42930145
AB - Background Machine perfusion has emerged as a promising strategy to attenuate ischemia-reperfusion injury during liver transplantation (LT). However, its impact on hepatocellular carcinoma (HCC) recurrence and post-transplant oncologic outcomes remains uncertain. We performed a systematic review and meta-analysis evaluating the association between machine perfusion and oncologic outcomes after LT for HCC.Methods A systematic literature search of PubMed/MEDLINE, Embase, and Web of Science was conducted from database inception to May 2026. Comparative clinical studies evaluating machine perfusion and oncologic outcomes after LT for HCC were included. The primary outcome was recurrence-free survival (RFS). Secondary outcomes included HCC recurrence, early recurrence, overall survival (OS), and graft-related outcomes. Risk of bias was assessed using the ROBINS-I tool. Random-effects meta-analyses were performed when appropriate.Results Six comparative clinical studies involving HCC recipients undergoing LT were included. All studies were observational, and no randomized controlled trial was identified. Three studies were judged to have a moderate risk of bias and three were judged to have a serious risk of bias. In the primary RFS meta-analysis, machine perfusion was associated with a numerically lower risk of recurrence or death, although the pooled estimate did not reach statistical significance (HR 0.34, 95% CI 0.07-1.77; p = 0.20). The binary recurrence analysis also demonstrated a numerically lower risk of HCC recurrence after machine perfusion (RR 0.40, 95% CI 0.13-1.20; p = 0.10). Several studies reported favorable associations between machine perfusion and early recurrence, while large adjusted cohorts reported associations with improved RFS and OS. Machine perfusion was generally associated with lower markers of ischemia-reperfusion injury, including postoperative aminotransferase release.Conclusions Current evidence suggests a potential favorable association between machine perfusion and oncologic outcomes after LT for HCC. However, the pooled estimates from the primary analyses were not statistically significant, and the evidence remains limited by the small number of studies, observational designs, heterogeneity, and potential cohort overlap. Further prospective studies are required before an oncologic benefit of machine perfusion can be established.
SN - 1198-0052
SN - 1718-7729
ER -