title: Long-term Results of Domino Liver Transplantation for Hepatocellular Carcinoma Using the "Double Piggy-back" Technique: A 13-Year Experience.
abstract: OBJECTIVE
  The aim of this study was to evaluate the long-term outcome of liver transplantation (LT) for hepatocellular carcinoma (HCC) with Domino LT (DLT) using the "Double Piggy-back" technique.
  
  
  BACKGROUND
  DLT using livers from familial amyloidotic polyneuropathy (FAP) patients is a well-described technique and useful for expanding the donor pool. However, data on long-term results for HCC are limited, particularly regarding the use of the "Double Piggy-back" technique.
  
  
  METHODS
  Between 2001 and 2014, a total of 260 patients undergoing LT for HCC were analyzed from a prospective database. Of those, 114 were submitted to DLT. Comparisons between groups were performed using propensity score matching.
  
  
  RESULTS
  Median follow-up was 34 months (1-152). Overall and disease-free 5-year survival rates for the whole population were 58% and 56%, respectively. There were 177 (68%) patients within Milan Criteria and an additional 26 (10%) within University of California San Francisco (UCSF) criteria. Patients older than 50 years were more likely to receive an FAP liver [odds ratio (OR) 1.94, confidence interval (CI) 1.02-3.69]. DLT patients had more major complications (23.7% vs 13.0%, P = 0.025). Only patients undergoing DLT presented with piggy-back syndrome (7% vs 0%, P = 0.001). After adjusting for potential confounders, DLT and cadaveric LT had a similar 5-year survival rate (59% vs 44%, respectively, P = 0.117). Thirteen patients (11.4%) evidenced FAP disease but not before 6 years after DLT.
  
  
  CONCLUSIONS
  DLT for HCC is feasible and achieves equivalent results to cadaveric LT. The benefit of expanding the donor pool must be balanced against higher morbidity and a real risk of disease transmission.
authors.affiliation: Hepato-Biliary-Pancreatic and Transplantation Centre, Curry Cabral Hospital, Lisbon Central Hospitals Centre, Lisbon, Portugal.
authors.forename: Hugo Pinto
authors.initials: HP
authors.lastname: Marques
authors.forename: Vasco
authors.initials: V
authors.lastname: Ribeiro
authors.forename: Tânia
authors.initials: T
authors.lastname: Almeida
authors.forename: João
authors.initials: J
authors.lastname: Aniceto
authors.forename: Sílvia
authors.initials: S
authors.lastname: Silva
authors.forename: Mafalda
authors.initials: M
authors.lastname: Sobral
authors.forename: Élia
authors.initials: É
authors.lastname: Mateus
authors.forename: Américo
authors.initials: A
authors.lastname: Martins
authors.forename: Eduardo
authors.initials: E
authors.lastname: Barroso
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011174:Portugal / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014019:Tissue Donors; D016896:Treatment Outcome