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Living Donor Liver Transplantation for Hepatocellular Carcinoma: It Is All about Donors?
1Division of Organ Transplantation, Department of Surgery, Alpert Medical School of Brown University, Providence, USA.
Insights
Live-donor liver transplantation (LDLT) offers comparable survival outcomes to deceased-donor liver transplantation (DDLT) for hepatocellular carcinoma (HCC) patients. LDLT is less necessary now due to MELD prioritization, except in regions with organ shortages.
Area of Science:
- Hepatobiliary surgery
- Transplant oncology
- Organ transplantation outcomes
Background:
- Live-donor liver transplantation (LDLT) is a viable alternative for hepatocellular carcinoma (HCC) patients, enabling early tumor removal.
- Deceased-donor liver transplantation (DDLT) is the traditional approach for HCC liver transplants.
Purpose of the Study:
- To compare the outcomes of adult patients with HCC who underwent LDLT versus DDLT in the USA between 1990 and 2009.
- To evaluate patient and allograft survival rates, wait times, and tumor characteristics in LDLT versus DDLT for HCC.
Main Methods:
- Retrospective review of adult HCC patients undergoing LDLT or DDLT from 1990-2009.
- Data sourced from the United Network for Organ Sharing (UNOS) registry.
- Analysis of patient demographics, tumor status (including Milan criteria), wait times, and survival outcomes.
Main Results:
- LDLT recipients for HCC were more likely to be female, younger, and have tumors outside Milan criteria compared to DDLT recipients.
- LDLT recipients experienced significantly shorter wait times (173 vs. 219 days).
- Overall allograft and patient survival rates were similar between LDLT and DDLT groups, despite more LDLT patients exceeding Milan criteria. DDLT for HCC increased significantly after MELD exception implementation, while LDLT remained stable.
Conclusions:
- LDLT provides comparable long-term survival outcomes to DDLT for HCC patients.
- The current MELD prioritization system for HCC reduces the need for LDLT, except in areas facing severe organ scarcity.
- Regional variations in LDLT rates for HCC were observed, with higher rates in regions 1, 5, and 9.
Background:
Live-donor liver transplantation (LDLT) is a valuable option for patients with hepatocellular carcinoma (HCC) as compared with deceased-donor liver transplantation (DDLT); the tumor could be eradicated early.
Methods:
Herein, we reviewed the outcome of adult patients with HCC who underwent LDLT from 1990 to 2009 in the USA, as reported to United Network for Organ Sharing.
Results:
Compared to DDLT (n=5858), patients who underwent LDLT for HCC (n=170) were more likely to be female (43.8% vs 23.8%), younger (mean age 48.6 vs 54.9 years) and have more tumors outside Milan criteria (30.7% vs 13.6%). However, the recipients of LDLT for HCC had a significantly shorter mean wait time before transplantation (173 vs 219 days; p=0.04). The overall allograft and patient survival were not different, though more patients in LDLT group were outside Milan criteria. Since implementation of the MELD exception for HCC, DDLT for HCC has increased form 337 (2.3%) cases in 2002 to 1142 (18.7%) in 2009 (p<0.001). However, LDLT for HCC has remained stable from 16 (5.7%) in 2002 to 14 (9.2%) in 2009 (p=0.1). Regions 1, 5 and 9 had the highest rate of LDLT for HCC compared to other regions.
Conclusions:
LDLT can achieve the same long-term outcomes compared to DDLT in patients with HCC. The current MELD prioritization for HCC reduces the necessity of LDLT for HCC except in areas with severe organ shortage.
