Hypothermic Oxygenated Machine Perfusion Reduces HCC Recurrence After LT: JHEP March 2026

Recurrence of hepatocellular carcinoma (HCC) after liver transplantation occurs in 15–20% of patients and remains a major determinant of post-transplant survival. This international matched cohort study evaluated whether hypothermic oxygenated machine perfusion (HOPE) of donor livers could influence oncologic outcomes after transplantation.

The study included 599 HCC recipients from the multicenter HOPE-REAL cohort (2012–2022) who received grafts preserved using HOPE-based perfusion strategies. Outcomes were compared using propensity matching with both non-HCC recipients and external controls receiving conventional non-perfused grafts.

The overall HCC recurrence rate was low (6.9%) in the HOPE-treated cohort. One-, three-, and five-year overall survival rates were 92%, 86%, and 81%, while recurrence-free survival reached 78% at 5 years. Importantly, 5-year survival was significantly higher in HOPE-treated HCC recipients compared with matched recipients of non-perfused grafts (84% vs 74%). Survival was also comparable to transplant outcomes in non-HCC recipients.

These findings suggest that HOPE may reduce ischemia-reperfusion injury and graft inflammation, potentially lowering tumor recurrence risk after transplantation. If validated in randomized trials, machine perfusion could become an important strategy to improve oncologic outcomes in liver transplantation for HCC.