Comparative Study of Living and Deceased Donor Liver Transplantation as a Treatm

[Clark]

http://www.journalacs.org/article/S1072-7515(14)01880-8/abstract

Comparative Study of Living and Deceased Donor Liver Transplantation as a Treatment for Hepatocellular Carcinoma
Mizuki Ninomiya, MD, PhDcorrespondenceemail, Ken Shirabe, MD, PhD, FACS, Marcelo E. Facciuto, MD, Myron E. Schwartz, MD, Sander S. Florman, MD, FACS, Tomoharu Yoshizumi, MD, PhD, FACS, Norifumi Harimoto, MD, PhD, Toru Ikegami, MD, PhD, FACS, Hideaki Uchiyama, MD, PhD, Yoshihiko Maehara, MD, PhD, FACS
DOI: http://dx.doi.org/10.1016/j.jamcollsurg.2014.12.009
Journal of the American College of Surgeons

Background
Living donor liver transplantation (LDLT) is an important treatment option for unresectable hepatocellular carcinoma (HCC), but whether recurrence and survival in LDLT differ from those in deceased donor liver transplantation (DDLT) remains controversial.

Study Design
A retrospective analysis was performed between patients with HCC who underwent LDLT in a Japanese institute (n=133) and those who underwent DDLT in a United States institute (n=362).

Results
Although there was a difference in patient background characteristics (eg, body mass index, donor age, MELD score), tumor aggressiveness represented by Milan criteria and microscopic vascular invasion were comparable between the two groups. The cumulative 5-year recurrence rates of the LDLT group and the DDLT group were similar (14.8 % vs 19.0 %, P=0.638), but overall survival in the LDLT group was significantly better than that in the DDLT group (84.2 % vs 63.5 %, P<0.0001). Separate multivariate analysis identified different preoperative predictive factors for HCC recurrence (salvage transplantation and Des-gamma-carboxy prothrombin > 300 in the LDLT group, beyond Milan criteria in the DDLT group). Combined multivariate analysis of the 2 groups identified recipient’s BMI > 30 kg/m2 as an independent risk factor for overall survival; the technique of transplantation (LDLT or DDLT) was not found to be a risk factor.

Conclusions
When compared between the institutes where LDLT/DDLT were the first treatment choices for unresectable HCC, recurrence rates were comparable. LDLT is a viable treatment option for unresectable HCC, providing similar recurrence rates to those achieved with DDLT.