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Survival Analysis after Living Donor Liver Transplantation for Hepatocellular Carcinoma: A Single Center Cohort Study
Byung-Gon Na1, Seong-Hoon Kim1, Sang-Jae Park1
1Organ Transplantation Center, National Cancer Center, 323 Ilsan-ro, Ilsandong-gu, Goyang-si 10408, Gyeonggi-do, Korea.
Insights
Living-donor liver transplantation (LDLT) for liver cancer (HCC) offers a cure. Patients beyond Milan criteria and high AFP levels (>400 ng/mL) face poorer survival outcomes after LDLT.
Area of Science:
- Hepatobiliary Surgery
- Transplant Oncology
- Surgical Oncology
Background:
- Living-donor liver transplantation (LDLT) is a vital curative option for hepatocellular carcinoma (HCC) due to donor organ scarcity.
- Investigating survival outcomes is crucial for optimizing LDLT in HCC management.
Purpose of the Study:
- To evaluate the survival outcomes, including overall survival (OS) and recurrence-free survival (RFS), following LDLT for HCC.
- To identify prognostic factors influencing survival in patients undergoing LDLT for HCC.
Main Methods:
- A cohort of 359 patients undergoing LDLT for HCC was analyzed.
- Overall survival (OS) and recurrence-free survival (RFS) were assessed.
- Prognostic factors for OS and RFS were determined using statistical analysis.
Main Results:
- Patients within Milan criteria (WM) demonstrated significantly better 5-year OS (87.3%) and RFS (87.6%) compared to those beyond criteria (BM) (64.1% and 57.8%, respectively).
- Pretransplant factors like alpha-fetoprotein (AFP) > 400 ng/mL and HCC beyond Milan criteria were independent risk factors for OS and RFS.
- Explanted liver pathology, including tumor size, high Edmondson-Steiner grade, and microvascular invasion, independently predicted poorer OS and RFS.
Conclusions:
- Hepatocellular carcinoma (HCC) beyond Milan criteria and pretransplant AFP levels > 400 ng/mL are unfavorable predictors of survival after LDLT.
- Pathological features of the explanted liver are critical determinants of post-transplant outcomes in HCC patients.
Background:
Living-donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) has been used as a curative treatment option for hepatocellular carcinoma (HCC) because of a shortage of deceased donors. This study aimed to investigate survival outcomes after LDLT for HCC.
Method:
This study included 359 patients undergoing LDLT for HCC. We analyzed overall survival (OS) and recurrence-free survival (RFS) and the prognostic factors related to them.
Results:
The 5-year OS and RFS rates of patients within the Milan criteria (WM) were better than those of patients beyond the Milan criteria (BM) (87.3% vs. 64.1% and 87.6% vs. 57.8%, respectively, both p < 0.05). Alpha-fetoprotein level (AFP) > 400 ng/mL (hazard ratio (HR), 2.07; 95% CI, 1.28-3.36; p < 0.05) and HCC of BM (HR, 2.61; 95% CI, 1.60-4.26; p < 0.05) at immediate pretransplant were independent risk factors of OS. AFP > 400 ng/mL (HR, 2.16; 95% CI, 1.34-3.49; p < 0.05) and HCC of BM (HR, 3.01; 95% CI, 1.81-5.01; p < 0.05) were also independent risk factors of RFS. In pathologic findings of explanted liver, tumor size, Edmondson-Steiner grade III-IV, and microvascular invasion were independent risk factors of both OS and RFS (p < 0.05).
Conclusions:
BM and AFP > 400 ng/mL at immediate pretransplant are unfavorable predictors of survival outcomes after LDLT for HCC.
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