Source
1 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3 Address correspondence to: Kwang-Woong Lee, M.D., Department of Surgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul 110-744, Korea.
Abstract
BACKGROUND:
Living-donor liver transplantation (LDLT) is becoming an important tool in hepatocellular carcinoma (HCC) treatment. However, the oncologic outcome between LDLT and deceased-donor LT (DDLT) for HCC remains controversial. This study aims to compare the HCC recurrence rates after LDLT versus DDLT.
METHODS:
Two hundred sixteen patients (166 LDLTs and 50 DDLTs) who underwent LT for HCC within University of California-San Francisco criteria were retrospectively reviewed. LDLT patients were divided into two groups: small living-donor graft (LDG; graft-to-recipient body weight ratio<1.0, n=59) and nonsmall LDG (graft-to-recipient body weight ratio≥1.0, n=107). Patients were further stratified into low- and high-risk settings by the number of risk factors for recurrence.
RESULTS:
The recurrence-free survival was lower in LDLT compared with DDLT (88.6% and 80.7% vs. 96.0% and 94.0% at 1 and 5 years; P=0.045). There was no significant difference between two groups regarding the majority of clinical and tumor characteristics, with the exception of a higher proportion of microvascular invasion presence in LDLT. After the adjustment for microvascular invasion, LDLT was identified as an independent risk factor for recurrence. Moreover, recurrence-free survival between small and nonsmall LDG was not statistically significant. In low-risk setting (≤1 risk factor), LDLT showed comparable outcome with DDLT. However, the risk of recurrence was higher in LDLT than DDLT in high-risk patients.
CONCLUSION:
In conclusion, LDLT showed poorer outcome than DDLT. This should be considered to select optimal strategy for HCC.