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Abstract Details
National Experience with Living Donor Liver Transplantation (LDLT) for Hepatocellular Carcinoma (HCC)
Liver Transpl. 2022 Feb 28. doi: 10.1002/lt.26439. Online ahead of print.
Jordyn Silverstein1, Francis Y Yao12, Joshua D Grab2, Hillary J Braun2, John Roberts2, Jennifer L Dodge23, Neil Mehta1
Author information
Division of Gastroenterology, Department of Medicine, University of California, San Francisco.
Division of Transplant Surgery, Department of Surgery, University of California, San Francisco.
Department of Gastroenterology and Liver Diseases, University of Southern California Keck School of Medicine, Los Angeles.
Abstract
Living donor liver transplantation (LDLT) is an attractive option to decrease waitlist dropout, particularly for HCC patients who face lengthening wait times. Using the UNOS national database, trends in LDLT utilization for HCC patients were evaluated, and compared post-LT outcomes for LDLT versus deceased donor liver transplantation (DDLT). From 1998-2018, LT was performed in 20,161 HCC patients including 726 (3.6%) who received LDLT. Highest LDLT utilization was prior to the 2002 HCC MELD exception policy (17.5%) and dropped thereafter (3.1%) with slight increase with the 6-month wait policy in 2015 (3.8%). LDLT was more common in patients from long wait UNOS regions with blood type O, in those with larger total tumor diameter (2.3 vs 2.1 cm, p=0.02) and higher AFP at LT (11.5 vs 9.0 ng/ml, p=0.04). 5-year post-LT survival (LDLT 77% vs DDLT 75%), graft survival (72% vs 72%) and HCC recurrence (11% vs 13%) were similar between groups (all p>0.20). In conclusion, LDLT utilization for HCC has remained low since 2002 with only a slight increase after the 6-month wait policy introduction in 2015. Given excellent post-LT survival, LDLT appears to be an underutilized but valuable option for HCC patients, especially those at high-risk for waitlist dropout.