Outcomes of living and deceased donor liver transplant recipients with hepatocellular carcinoma: results of the A2ALL cohort

Abstract

Hepatocellular carcinoma (HCC) represents an increasing fraction of liver transplant indications; the role of living donor liver transplant (LDLT) remains unclear. In the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, patients with HCC and an LDLT or deceased donor liver transplant (DDLT) for which at least one potential living donor had been evaluated were compared for recurrence and posttransplant mortality rates. Mortality from date of evaluation of each recipient's first potential living donor was also analyzed. Unadjusted 5-year HCC recurrence was significantly higher after LDLT (38%) than DDLT (11%), (p = 0.0004). After adjustment for tumor characteristics, HCC recurrence remained significantly different between LDLT and DDLT recipients (hazard ratio (HR) = 2.35; p = 0.04) for the overall cohort but not for recipients transplanted following the introduction of MELD prioritization. Five-year posttransplant survival was similar in LDLT and DDLT recipients from time of transplant (HR = 1.32; p = 0.27) and from date of LDLT evaluation (HR = 0.73; p = 0.36). We conclude that the higher recurrence observed after LDLT is likely due to differences in tumor characteristics, pretransplant HCC management and waiting time.

Conflict of interest statement

Disclosures:

The authors of this manuscript have conflicts of interest to disclose as described by the American Journal of Transplantation.

Laura Kulik- Advisory Committees: Bayer/Onyx; Grant/Research Support: Bayer/Onyx; Speaking and Teaching: Bayer/Onyx

Anna S. Lok- Consulting: Roche, Gilead, Bristol –Myers Squibb, Bayer; Grant/Research Support: Bristol –Myers Squibb, GlaxoSmithKline, Schering-Plough, Roche, Gilead

Robert S. Brown- Grant/Research Support: Gilead, GSK, Novartis, Salix, Schering/Merck, Vertex; Speaking and Teaching: Salix Pharmaceuticals, Roche/Genentech, Gilead, Schering/Merck

Greg T. Everson – Advisory Committee or Review Panels: Roche, Merck, Three Rivers, Hep C Connection; Board membership: HepQuant LLC, PSC partners; Consulting: Genentech; Grant/Research Support: Roche, Pharmassett, Vertex, GSK, Schering-Plough, Bristol-Myers Squibb, Tibotec, Human Genome Sciences/Novartis, GlobeImmune, OrthoBiotech, Medtronic, Pfizer, Eisai, Abbott, Conatus, ZymoGenetics, PSC Partners; Management Position: HepQuant LLC; Patent Held/Filed: Univ of Colorado

These authors have nothing to disclose: Robert A. Fisher, Del R. Rodrigo, Christopher E. Freise, Abraham Shaked, Johnny C. Hong, Paul H. Hayashi, Carl L. Berg, James E. Everhart

© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons.

Figures

Figure 1

Cumulative probability over time of LDLT, DDLT, remaining alive on the waitlist, and death without transplant, from the first living donor evaluation (based on the cumulative incidence function) for (a) HCC patients in the Pre-MELD Era and (b) HCC patients in the MELD era.

Figure 2

Probability of freedom from HCC recurrence by time since LDLT or DDLT for (a) all HCC patients (unadjusted), (b) HCC patients in the MELD era (unadjusted), and (c) all HCC patients (adjusted based on a Cox regression model, with both LDLT and DDLT groups presented for the overall average baseline characteristic values of two liver nodules, largest nodule 3.5 cm, and without vascular invasion).

Figure 3

Unadjusted probability of patient survival by time since LDLT or DDLT for (a) all HCC patients and (b) HCC patients in the MELD era.

Figure 4

Unadjusted probability of recurrence-free survival by time since LDLT or DDLT for (a) all HCC patients and (b) HCC patients in the MELD era.

Figure 5

Adjusted probability of patient mortality by time from first living donor evaluation, for (a) all HCC patients and (b) HCC patients in the MELD era, both based on Cox regression models with both LDLT and DDLT groups presented for the average baseline characteristic values (55 years old, beyond Milan, AFP=10, lab MELD=12, and without ablation).