†This is publication 19 of the Adult-to-Adult Living Donor Liver Transplantation Cohort Study.
Outcomes of Living and Deceased Donor Liver Transplant Recipients With Hepatocellular Carcinoma: Results of the A2ALL Cohort†
Article first published online: 20 SEP 2012
© Copyright 2012 The American Society of Transplantation and the American Society of Transplant Surgeons
American Journal of Transplantation
Volume 12, Issue 11, pages 2997–3007, November 2012
How to Cite
Kulik, L. M., Fisher, R. A., Rodrigo, D. R., Brown, Jr., R. S., Freise, C. E., Shaked, A., Everhart, J. E., Everson, G. T., Hong, J. C., Hayashi, P. H., Berg, C. L., Lok, A. S. F. and the A2ALL Study Group (2012), Outcomes of Living and Deceased Donor Liver Transplant Recipients With Hepatocellular Carcinoma: Results of the A2ALL Cohort. American Journal of Transplantation, 12: 2997–3007. doi: 10.1111/j.1600-6143.2012.04272.x
- Issue published online: 27 OCT 2012
- Article first published online: 20 SEP 2012
- Received 19 March 2012, revised 26 June 2012 and accepted for publication 27 June 2012
- loco-regional therapy;
- MELD score;
- Milan criteria;
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.