Hepatocellular carcinoma recurrence and death following living and deceased donor liver transplantation

Abstract

We examined mortality and recurrence of hepatocellular carcinoma (HCC) among 106 transplant candidates with cirrhosis and HCC who had a potential living donor evaluated between January 1998 and February 2003 at the nine centers participating in the Adult-to-Adult Living Donor Liver Transplantation Cohort Study (A2ALL). Cox regression models were fitted to compare time from donor evaluation and time from transplant to death or HCC recurrence between 58 living donor liver transplant (LDLT) and 34 deceased donor liver transplant (DDLT) recipients. Mean age and calculated Model for End-Stage Liver Disease (MELD) scores at transplant were similar between LDLT and DDLT recipients (age: 55 vs. 52 years, p = 0.21; MELD: 13 vs. 15, p = 0.08). Relative to DDLT recipients, LDLT recipients had a shorter time from listing to transplant (mean 160 vs. 469 days, p < 0.0001) and a higher rate of HCC recurrence within 3 years than DDLT recipients (29% vs. 0%, p = 0.002), but there was no difference in mortality or the combined outcome of mortality or recurrence. LDLT recipients had lower relative mortality risk than patients who did not undergo LDLT after the center had more experience (p = 0.03). Enthusiasm for LDLT as HCC treatment is dampened by higher HCC recurrence compared to DDLT.

Figures

Figure 1

Cumulative probability over time of LDLT, DDLT, death without transplant, and remaining alive on the wait-list, from the point of first potential living donor evaluation (based on the cumulative incidence function).

Figure 2. Probability of freedom from HCC recurrence by time since LDLT or DDLT

Freedom from HCC recurrence was significantly lower in LDLT recipients compared to DDLT recipients (p = 0.002, log-rank test).

Figure 3. Probability of recurrence-free patient survival by time since LDLT or DDLT

Recurrence-free survival was lower in LDLT recipients compared to DDLT recipients, but the difference was not significant (p = 0.38, log-rank test).