3 years ago

Live Donor Liver Transplantation for Patients with Hepatocellular Carcinoma Offers Increased Survival vs. Deceased Donation

Nicolas Goldaracena, Andre Gorgen, Adam Doyle, Bettina E. Hansen, Koji Tomiyama, Wei Zhang, Anand Ghanekar, Les Lilly, Mark Cattral, Zita Galvin, Markus Selzner, Mamatha Bhat, Nazia Selzner, Ian Mcgilvray, Paul D. Greig, David R. Grant, Gonzalo Sapisochin

Publication date: Available online 8 January 2019

Source: Journal of Hepatology

Author(s): Nicolas Goldaracena, Andre Gorgen, Adam Doyle, Bettina E. Hansen, Koji Tomiyama, Wei Zhang, Anand Ghanekar, Les Lilly, Mark Cattral, Zita Galvin, Markus Selzner, Mamatha Bhat, Nazia Selzner, Ian McGilvray, Paul D. Greig, David R. Grant, Gonzalo Sapisochin

Abstract
Background & Aim

There are conflicting reports on the outcomes of patients with hepatocellular carcinoma (HCC) after live donor liver transplantation. We aimed to compare the survival of patients with HCC, with a potential live donor (pLDLT) at listing versus no potential donor (pDDLT), on an intention-to-treat basis.

Methods

All patients with HCC listed for liver transplantation between 2000-2015 were included. The pLDLT group was comprised of recipients with a potential live donor identified at listing. Patients without a live donor were included in the pDDLT group. Survival was assessed by the Kaplan-Meier method. Multivariable Cox regression was applied to identify potential predictors of mortality.

Results

219 patients were included in the pLDLT group and 632 patients in the pDDLT group. In the pLDLT group, 57 patients (26%) were beyond the UCSF criteria whereas 119 patients (19%) in the pDDLT were beyond (p=0.02). Time on the waiting list was shorter for the pLDLT compared to the pDDLT [4.8 (2.9-8.5) months vs. 6.2 (3.0-12.0) months, respectively, p=0.02]. The dropout rate was 32/219 (14.6%) in the pLDLT and 174/632 (27.5%) in the pDDLT, p<0.001. The 1-, 3- and 5-year intention-to-treat survival was 86%, 72% and 68% in the pLDLT vs. 82%, 63% and 57% in the pDDLT, p=0.02. Having a pLDLT was a protective factor for death [HR=0.67 (95%CI 0.53-0.86)]. Waiting times of 9-12 months [HR=1.53 (95%CI 1.02-2.31)] and ≥12 months [HR=1.69 (95%CI 1.23-2.32)] were predictors of death.

Conclusion

Having a potential live donor at listing was associated with a significant decrease in the risk of death in this intention-to-treat analysis. This benefit is related to a lower dropout rate and a shorter waiting period.

Lay Abstract

Liver transplantation (LT) offers the best chance of survival for patients with hepatocellular carcinoma (HCC). Liver transplantation can be done using grafts from deceased donor or live donor. There are conflicting results on the outcomes of patients with HCC after live donation. In this work, we aimed to assess the differences in survival after live donor LT when compared to deceased donor LT. We studied 219 patients who have been listed for live donor LT and 632 patients who have been listed for deceased donor LT. Patients who had a potential live donor at the time of listing had a higher survival. Therefore, been listed for a live donor LT was a protective factor for death. These data show that having a potential live donor at listing was associated with a significant decrease in the risk of death for patients with HCC.

Graphical abstract

Graphical abstract for this article

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