Intention-to-treat analysis of liver transplantation for hepatocellular carcinoma: Living versus deceased donor transplantation

Authors

  • Prashant Bhangui,

    1. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
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  • Eric Vibert,

    1. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
    2. Université Paris-Sud, Villejuif, France
    3. INSERM, Unité 785, Villejuif, France
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  • Pietro Majno,

    1. Transplantation Unit, Department of Visceral Surgery, University Hospital of Geneva, Geneva, Switzerland
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  • Chady Salloum,

    1. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
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  • Paola Andreani,

    1. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
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  • Joao Zocrato,

    1. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
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  • Philippe Ichai,

    1. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
    2. INSERM, Unité 785, Villejuif, France
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  • Faouzi Saliba,

    1. Université Paris-Sud, Villejuif, France
    2. INSERM, Unité 785, Villejuif, France
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  • Rene Adam,

    1. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
    2. Université Paris-Sud, Villejuif, France
    3. INSERM, Unité 785, Villejuif, France
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  • Denis Castaing,

    1. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
    2. Université Paris-Sud, Villejuif, France
    3. INSERM, Unité 785, Villejuif, France
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  • Daniel Azoulay

    Corresponding author
    1. Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, Villejuif, France
    2. Université Paris-Sud, Villejuif, France
    3. INSERM, Unité 1004, Villejuif, France
    • Centre Hépato-Biliaire, Hôpital Paul Brousse, Assistance Publique-Hôpitaux de Paris, 12 Avenue Paul Vaillant Couturier, 94804 Villejuif, France
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  • Potential conflict of interest: Nothing to report.

Abstract

For patients who have cirrhosis with hepatocellular carcinoma (HCC), living donor liver transplantation (LDLT) reduces waiting time and dropout rates. We performed a comparative intention-to-treat analysis of recurrence rates and survival outcomes after LDLT and deceased donor liver transplantation (DDLT) in HCC patients. Our study included 183 consecutive patients with HCC who were listed for liver transplantation over a 9-year period at our institution. Tumor recurrence was the primary endpoint. At listing, patient and tumor characteristics were comparable in the two groups (LDLT, n = 36; DDLT, n = 147). Twenty-seven (18.4%) patients dropped out, all from the DDLT waiting list, mainly due to tumor progression (19/27 [70%] patients). The mean waiting time was shorter in the LDLT group (2.6 months versus 7.9 months; P = 0.001). The recurrence rates in the two groups were similar (12.9% and 12.7%, P = 0.78), and there was a trend toward a longer time to recurrence after LDLT (38 ± 27 months versus 16 ± 13 months, P = 0.06). Tumors exceeding the University of California, San Francisco (UCSF) criteria, tumor grade, and microvascular invasion were independent predictive factors for recurrence. On an intention-to-treat basis, the overall survival (OS) in the two groups was comparable. Patients beyond the Milan and UCSF criteria showed a trend toward worse outcomes with LDLT compared with DDLT (P = 0.06). Conclusion: The recurrence and survival outcomes after LDLT and DDLT were comparable on an intent-to-treat analysis. Shorter waiting time preventing dropouts is an additional advantage with LDLT. LDLT for HCC patients beyond validated criteria should be proposed with caution. (HEPATOLOGY 2011;)

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