title: Intention-to-treat analysis of liver transplantation for hepatocellular carcinoma: living versus deceased donor transplantation.
abstract: For patients who have cirrhosis with hepatocellular carcinoma (HCC), living donor liver transplantation (LDLT) reduces waiting time and dropout rates. We performed a comparative intention-to-treat analysis of recurrence rates and survival outcomes after LDLT and deceased donor liver transplantation (DDLT) in HCC patients. Our study included 183 consecutive patients with HCC who were listed for liver transplantation over a 9-year period at our institution. Tumor recurrence was the primary endpoint. At listing, patient and tumor characteristics were comparable in the two groups (LDLT, n = 36; DDLT, n = 147). Twenty-seven (18.4%) patients dropped out, all from the DDLT waiting list, mainly due to tumor progression (19/27 [70%] patients). The mean waiting time was shorter in the LDLT group (2.6 months versus 7.9 months; P = 0.001). The recurrence rates in the two groups were similar (12.9% and 12.7%, P = 0.78), and there was a trend toward a longer time to recurrence after LDLT (38 ± 27 months versus 16 ± 13 months, P = 0.06). Tumors exceeding the University of California, San Francisco (UCSF) criteria, tumor grade, and microvascular invasion were independent predictive factors for recurrence. On an intention-to-treat basis, the overall survival (OS) in the two groups was comparable. Patients beyond the Milan and UCSF criteria showed a trend toward worse outcomes with LDLT compared with DDLT (P = 0.06).
  
  
  CONCLUSIONS
  The recurrence and survival outcomes after LDLT and DDLT were comparable on an intent-to-treat analysis. Shorter waiting time preventing dropouts is an additional advantage with LDLT. LDLT for HCC patients beyond validated criteria should be proposed with caution.
authors.affiliation: Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France.
authors.forename: Prashant
authors.initials: P
authors.lastname: Bhangui
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
authors.forename: Pietro
authors.initials: P
authors.lastname: Majno
authors.forename: Chady
authors.initials: C
authors.lastname: Salloum
authors.forename: Paola
authors.initials: P
authors.lastname: Andreani
authors.forename: Joao
authors.initials: J
authors.lastname: Zocrato
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichai
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.forename: Rene
authors.initials: R
authors.lastname: Adam
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000601:surgery*; D005260:Female; D006801:Humans; D057194:Intention to Treat Analysis; D008113:Liver Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D014019:Tissue Donors