title: Outcomes of living and deceased donor liver transplant recipients with hepatocellular carcinoma: results of the A2ALL cohort.
abstract: Hepatocellular carcinoma (HCC) represents an increasing fraction of liver transplant indications; the role of living donor liver transplant (LDLT) remains unclear. In the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, patients with HCC and an LDLT or deceased donor liver transplant (DDLT) for which at least one potential living donor had been evaluated were compared for recurrence and posttransplant mortality rates. Mortality from date of evaluation of each recipient's first potential living donor was also analyzed. Unadjusted 5-year HCC recurrence was significantly higher after LDLT (38%) than DDLT (11%), (p = 0.0004). After adjustment for tumor characteristics, HCC recurrence remained significantly different between LDLT and DDLT recipients (hazard ratio (HR) = 2.35; p = 0.04) for the overall cohort but not for recipients transplanted following the introduction of MELD prioritization. Five-year posttransplant survival was similar in LDLT and DDLT recipients from time of transplant (HR = 1.32; p = 0.27) and from date of LDLT evaluation (HR = 0.73; p = 0.36). We conclude that the higher recurrence observed after LDLT is likely due to differences in tumor characteristics, pretransplant HCC management and waiting time.
authors.affiliation: Department of Medicine and Surgery, Northwestern University, Chicago, IL, USA.
authors.forename: L M
authors.initials: LM
authors.lastname: Kulik
authors.forename: R A
authors.initials: RA
authors.lastname: Fisher
authors.forename: D R
authors.initials: DR
authors.lastname: Rodrigo
authors.forename: R S
authors.initials: RS
authors.lastname: Brown
authors.forename: C E
authors.initials: CE
authors.lastname: Freise
authors.forename: A
authors.initials: A
authors.lastname: Shaked
authors.forename: J E
authors.initials: JE
authors.lastname: Everhart
authors.forename: G T
authors.initials: GT
authors.lastname: Everson
authors.forename: J C
authors.initials: JC
authors.lastname: Hong
authors.forename: P H
authors.initials: PH
authors.lastname: Hayashi
authors.forename: C L
authors.initials: CL
authors.lastname: Berg
authors.forename: A S F
authors.initials: AS
authors.lastname: Lok
mesh_terms: D000328:Adult; D002102:Cadaver; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology*; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000401:mortality / Q000503:physiopathology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome