title: The effect of graft type on mortality in liver transplantation for hepatocellular carcinoma.
abstract: BACKGROUND
  Liver transplantation (LT) with living-donor (LD-P) and deceased-donor (DD-P) partial grafts for hepatocellular carcinoma (HCC) may be associated with worse outcomes. Using the United Network for Organ Sharing (UNOS), we aimed to: (1) examine the risk of mortality in LT for HCC, (2) to establish if this risk is affected by partial graft use, and (3) to determine if this effect is mitigated by improved tumor-associated risk stratification.
  
  
  METHODS
  All first-time adult LT recipients were analyzed (3/2002-12/2012), including 2,353 LD-P, 727 DD-P, and 47,833 DD whole (DD-W) grafts. Cox proportional hazards models were used to examine the risk of mortality given HCC. Interaction/subset analyses were used to examine the effect of tumor-risk and graft-type on outcome. Presence of an HCC exception and low alpha-fetoprotein (AFP) level (<66 ng/mL) were considered favorable.
  
  
  RESULTS
  Overall, HCC was associated with an increased mortality risk compared to the absence of HCC (HR 1.21 [1.15-1.27]), and the use of partial grafts was noted to further intensify this risk. However, HCC with a favorable risk profile had more comparable outcomes to patients without HCC and this finding was similar across all graft-types (Given LD-P: HR 1.14 [0.76-1.73]; Given DD-P: HR1.05 [0.71-1.56]; Given DD-W: HR1.08 [1.02-1.14]). On subset analysis, all graft types had similar outcomes given either favorable-risk HCC or the absence of HCC.
  
  
  CONCLUSIONS
  There is no significant difference in outcomes between whole and partial grafts given (1) patients with HCC with a favorable risk-profile or (2) patients without HCC.
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Cauley
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Kristina
authors.initials: K
authors.lastname: Potanos
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Nora
authors.initials: N
authors.lastname: Fullington
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: James
authors.initials: J
authors.lastname: Grijalva
authors.affiliation: Clinical Research Center, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Dionne A
authors.initials: DA
authors.lastname: Graham
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Heung Bae
authors.initials: HB
authors.lastname: Kim
authors.affiliation: Department of Surgery, Boston Children's Hospital, Boston, MA, USA.
authors.forename: Khashayar
authors.initials: K
authors.lastname: Vakili
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006085:Graft Survival; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D014019:Tissue Donors; D016896:Treatment Outcome