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Outcomes of Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation Utilizing Extended Criteria Donor Grafts

  • 0Department of Surgery, Houston Methodist Hospital, Houston, Texas.
Transplantation Proceedings +

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December 1, 2024

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December 1, 2024

View abstract on PubMed

Summary

This summary is machine-generated.

Extended criteria donor (ECD) liver grafts offer a solution to donor shortages but show slightly lower survival rates for hepatocellular carcinoma (HCC) patients compared to standard criteria donor (SCD) grafts. However, liver transplantation benefits still outweigh these differences.

Area Of Science

  • Transplantation Medicine
  • Hepatology
  • Organ Donation

Background

  • The shortage of deceased donor livers necessitates the use of extended criteria donor (ECD) grafts.
  • Hepatocellular carcinoma (HCC) patients, often with low MELD scores, are frequently recipients of ECD liver grafts.
  • Limited research exists on ECD graft outcomes specifically in HCC patients.

Purpose Of The Study

  • To evaluate the outcomes of liver transplantation (LT) using extended criteria donor (ECD) grafts in patients with hepatocellular carcinoma (HCC).
  • To compare graft and patient survival rates between standard criteria donor (SCD), ECD donation after brain death (ECD-DBD), and donation after circulatory death (DCD) liver grafts in HCC patients.

Main Methods

  • Adult liver transplant recipients for HCC from 2010-2020 were analyzed using the Organ Procurement and Transplantation Network (OPTN) database.
  • Recipients were stratified by donor type: SCD, ECD-DBD, and DCD.
  • Multivariable Cox regression identified predictors of 3-year overall and graft survival post-LT.

Main Results

  • ECD-DBD grafts were most common (51.4%), followed by SCD and DCD grafts.
  • Standard criteria donor (SCD) recipients demonstrated higher 5-year overall survival (79.1%) and graft survival (77.8%) compared to ECD-DBD (77.1%, 75.7%) and DCD (76.8%, 72.2%) recipients.
  • Donation after circulatory death (DCD) grafts significantly increased mortality risk (HR=1.33), while ECD-DBD grafts showed a non-significant trend towards increased risk (HR=1.10).

Conclusions

  • Both DCD and ECD-DBD liver grafts are associated with lower overall and graft survival rates in HCC patients compared to SCD grafts.
  • Despite minor survival differences, the benefits of liver transplantation for HCC patients significantly outweigh the risks associated with using ECD grafts.
  • Further investigation into strategies like machine perfusion for ECD grafts is warranted to improve outcomes.