Living donor versus deceased donor liver transplantation for early unresectable hepatocellular carcinoma: same criteria, different outcome

Abstract

INTRODUCTIONANDAIM: Hypothetical studies that supported the role of living donor liver transplantation (LDLT) for early unresectable hepatocellular carcinoma (HCC) assumed the same outcome as deceased donor liver transplantation (DDLT).Wetested this assumption with a clinical study. PATIENTS AND METHODS: We studied 60 consecutive patients who met the Milan or UCSF criteria on pretransplant imaging and underwent LDLT (LD group, n=43) or DDLT (DD group, n=17). RESULTS: Compared to the DD group, the LD group had fewer incidental tumors or pretransplant transarterial chemoembolization but more salvage transplantation for recurrence. There was a shorter waiting time and lower graft-weight-to-standard-liver-weight (GW/SLW) ratio. The perioperative course was the same in terms of transfusion, morbidity, mortality and hospital stay. Histopathologic analysis showed similar tumor size, number, grade, and stage. At a median follow-up of 28 months (range: 4–111), 7 (16%) patients of the LD group and none (0%) of the DD group recurred. The 1-, and 5-year cumulative recurrence rate was 9%, and 25%, respectively, for the LD group, and all 0%, for the DD group (p=0.05). The corresponding patient survival was 97% and 55%, respectively, for the LD group, and 94% and 94%, respectively, for the DD group (p=0.279). Apart from tumor factors including vascular permeation, tumor nodules 43, and a pathologic stage beyond UCSF criteria, GW/SLW ratio 50.6 and salvage transplantation were also risk factors for recurrence. CONCLUSION: Despite standard selection criteria, patients who undergo LDLT for early unresectable HCC have different clinical characteristics and inferior oncologic outcome.