Living-donor liver transplantation associated with higher incidence of hepatocellular carcinoma recurrence than deceased-donor liver transplantation.
BACKGROUND
Living-donor liver transplantation (LDLT) is becoming an important tool in hepatocellular carcinoma (HCC) treatment. However, the oncologic outcome between LDLT and deceased-donor LT (DDLT) for HCC remains controversial. This study aims to compare the HCC recurrence rates after LDLT versus DDLT.


METHODS
Two hundred sixteen patients (166 LDLTs and 50 DDLTs) who underwent LT for HCC within University of California-San Francisco criteria were retrospectively reviewed. LDLT patients were divided into two groups: small living-donor graft (LDG; graft-to-recipient body weight ratio <1.0, n=59) and nonsmall LDG (graft-to-recipient body weight ratio ≥1.0, n=107). Patients were further stratified into low- and high-risk settings by the number of risk factors for recurrence.


RESULTS
The recurrence-free survival was lower in LDLT compared with DDLT (88.6% and 80.7% vs. 96.0% and 94.0% at 1 and 5 years; P=0.045). There was no significant difference between two groups regarding the majority of clinical and tumor characteristics, with the exception of a higher proportion of microvascular invasion presence in LDLT. After the adjustment for microvascular invasion, LDLT was identified as an independent risk factor for recurrence. Moreover, recurrence-free survival between small and nonsmall LDG was not statistically significant. In low-risk setting (≤1 risk factor), LDLT showed comparable outcome with DDLT. However, the risk of recurrence was higher in LDLT than DDLT in high-risk patients.


CONCLUSIONS
In conclusion, LDLT showed poorer outcome than DDLT. This should be considered to select optimal strategy for HCC.
1 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3 Address correspondence to: Kwang-Woong Lee, M.D., Department of Surgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul 110-744, Korea.
Min-Su
MS
Park
Kwang-Woong
KW
Lee
Suk-Won
SW
Suh
Tae
T
You
Youngrok
Y
Choi
Hyeyoung
H
Kim
Geun
G
Hong
Nam-Joon
NJ
Yi
Choon-Hyuck David
CH
Kwon
Jae-Won
JW
Joh
Suk-Koo
SK
Lee
Kyung-Suk
KS
Suh
D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000209:etiology* / Q000401:mortality; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012495:San Francisco / Q000453:epidemiology; D013997:Time Factors; D016896:Treatment Outcome