Beyond graft function impairment after liver transplantation: the prolonged cold ischemia time impact on recurrence of hepatocellular carcinoma after liver transplantation-a single-center retrospective study

• Published in: PeerJ (San Francisco, CA) CA), 2024-10, Vol.12, p.e18126, Article e18126
• Main Authors: Yu, Jia, Yunhua, Tang, Guo, Yiwen, Dong, Yuqi, Gong, Jin Long, Wang, Tielong, Chen, Zhitao, Chen, Maogen, Ju, Weiqiang, He, Xiaoshun
• Format: Article
• Language: English
• Subjects: Adult; Allograft dysfunction; Aspartate; Bilirubin; Cancer; Carcinoma; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Care and treatment; Cold Ischemia - adverse effects; Diseases; Female; Gastroenterology and Hepatology; Gepatocellular carcinoma; Glycoproteins; Health aspects; Humans; Ischemia; Liver; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver transplantation; Liver Transplantation - adverse effects; Male; Medical research; Medicine, Experimental; Middle Aged; Mortality; Neoplasm Recurrence, Local; Oncology; Prolonged cold ischemia time; Relapse; Reperfusion Injury - etiology; Retrospective Studies; Risk Factors; Surgery and Surgical Specialties; Time Factors; Transplantation; Tumor recurrence
• ISSN: 2167-8359; 2167-8359
• DOI: 10.7717/peerj.18126

Hepatocellular carcinoma (HCC) is one of the malignant tumors responsible for high mortality and recurrence rates. Although liver transplantation (LT) is an effective treatment option for HCC, ischemia-reperfusion injury (IRI) is a contributor to HCC recurrence after LT. Moreover, prolonged cold ischemia time (CIT) is a risk factor for IRI during LT, and there is insufficient clinical evidence regarding the impact of CIT on HCC recurrence after LT. This retrospective study analyzed 420 patients who underwent LT for HCC between February 2015 and November 2020 at The First Affiliated Hospital, Sun Yat-sen University. The duration of CIT was defined as the time from clamping of the donor aorta until portal reperfusion. A total of 133 patients (31.7%) experienced tumor recurrence after LT, and CIT > 568 min was the independent risk factor for HCC recurrence (OR, 2.406; 95% CI [1.371-4.220]; = 0.002). Multivariate Cox's regression analysis revealed that the recipients' gender, exceeding Milan criteria, poor differentiation, and alpha-fetoprotein (AFP) ≥400 ng/ml in CIT > 568 min group were independent risk factors for disease-free survival. The peak 7-day postoperative alanine aminotransferase (ALT) level (