title: Potential role of the donor in hepatocellular carcinoma recurrence after liver transplantation.
abstract: A subset of liver transplantation (LT) recipients who undergo transplantation for hepatocellular carcinoma (HCC) will develop postoperative recurrence. There has yet to be a thorough investigation of donor factors influencing recurrence. Data regarding adult, primary LT recipients with HCC (n = 5002) who underwent transplantation between January 1, 2006 and September 30, 2010 were extracted from the United Network for Organ Sharing database, and the cumulative incidence of post-LT recurrence by donor factors was subsequently estimated. Among the HCC LT recipients, 324 (6.5%) developed recurrence. An analysis of donor characteristics demonstrated a higher cumulative incidence of recurrence within 4 years of transplantation among recipients with donors ≥ 60 years old (11.8% versus 7.3% with donors < 60 years old, P < 0.001) and with donors from a nonlocal share distribution (10.6% versus 7.4% with donors with a local share distribution, P = 0.004). The latter 2 findings held true in a multivariate analysis: the risk of HCC recurrence increased by 70% for recipients of livers from donors ≥ 60 years old [subhazard ratio (SHR) = 1.70, 95% confidence interval (CI) = 1.31-2.20, P < 0.001] and by 42% for recipients of nonlocal share distribution livers (SHR = 1.42, 95% CI = 1.09-1.84, P = 0.009) after adjustments for clinical characteristics. In conclusion, the consideration of certain donor factors may reduce the cumulative incidence of posttransplant HCC recurrence and thus improve long-term survival after LT.
authors.affiliation: Division of Transplant Surgery, Department of Surgery, Massachusetts General Hospital/Harvard Medical School, Boston, MA.
authors.forename: Parsia A
authors.initials: PA
authors.lastname: Vagefi
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Dodge
authors.forename: Francis Y
authors.initials: FY
authors.lastname: Yao
authors.forename: John P
authors.initials: JP
authors.lastname: Roberts
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009364:Neoplasm Recurrence, Local / Q000503:physiopathology*; D011184:Postoperative Period; D012042:Registries; D012189:Retrospective Studies; D012720:Severity of Illness Index; D014019:Tissue Donors; D016896:Treatment Outcome; D014481:United States