Pre-retrieval reperfusion decreases cancer recurrence after rat ischemic liver graft transplantation
Authors: JiWen Cheng, Yi Lv
Journal: Journal of Hepatology (2014)

Pre-retrieval reperfusion decreases cancer recurrence after rat ischemic liver graft transplantationJournal of HepatologyVol. 61Issue 2PreviewLiver transplantation from marginal donors is associated with ischemia/reperfusion (I/R) lesions, which may increase the risk of post-transplant hepatocellular carcinoma (HCC) recurrence. Graft reperfusion prior to retrieval (as for extracorporeal membrane oxygenation – ECMO) can prevent I/R lesions. The impact of I/R on the risk of cancer recurrence was assessed on a syngeneic Fischer-rat liver transplantation model. Full-Text PDF Open AccessReply to: “Pre-retrieval reperfusion decreases cancer recurrence after rat ischemic liver graft transplantation”Journal of HepatologyVol. 61Issue 4PreviewWe thank Drs Cheng and Lv [1] for their interest in our work suggesting an increased rate of hepatocellular carcinoma (HCC) recurrence/growth after transplantation of ischemic liver grafts, and the protective effect of in situ graft reperfusion prior to retrieval [2]. Full-Text PDF Open Access We read with great interest the article “Pre-retrieval reperfusion decreases cancer recurrence after rat ischemic liver graft transplantation” [[1]Oldani G. Crowe L.A. Orci L.A. et al.Pre-retrieval reperfusion decreases cancer recurrence after rat ischemic liver graft transplantation.J Hepatol. 2014; 61: 278-285Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar]. This elegant study assessed the impact of ischemic liver graft on the risk of cancer recurrence utilizing a rat liver transplantation model. Oldani et al. [[1]Oldani G. Crowe L.A. Orci L.A. et al.Pre-retrieval reperfusion decreases cancer recurrence after rat ischemic liver graft transplantation.J Hepatol. 2014; 61: 278-285Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar] demonstrated that ischemia/reperfusion lesions lead to an increased risk of post-transplant hepatocellular carcinoma (HCC) recurrence and growth, which can be reversed by graft reperfusion prior to retrieval. However, in this study, they clamped the vena porta and infra-hepatic vena cava during 10 or 30 min prior to flushing and retrieving the liver to simulate the ischemic donors, and the liver was reperfused for two hours after all clamps were removed at the end of the clamping to simulate ischemic/reperfused donors. Apparently, the quality of blood reperfused in this transplantation model is better than the perfusion solution used during normothermic extracorporeal membrane oxygenation (NECMO) after circulatory death in clinical situations to some extent [[2]Fondevila C. Hessheimer A.J. Flores E. et al.Applicability and results of Maastricht type 2 donation after cardiac death liver transplantation.Am J Transplant. 2012; 12: 162-170Crossref PubMed Scopus (160) Google Scholar]. Thus, we wonder if the risks of post-transplant cancer recurrence can be reduced by graft reperfusion with “perfusion solution” used in clinical prior to retrieval? In addition in a further study, it is necessary to estimate the combined feasibility and availability of pre-retrieval reperfusion with different NECMO time with the aim to reduce the risk of cancer recurrence and to repair and resuscitate the liver grafts from donation after cardiac death (DCD) donors. This may help to increase the yield of transplantable livers from this source for HCC candidates awaiting liver transplantation. The authors declared that they do not have anything to disclose regarding funding or conflict of interest with respect to this manuscript.