Author information
1
Multi-Organ Transplant Unit, Division of General Surgery, Department of Surgery, University Health Network. University of Toronto, Canada; Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Canada.
2
Multi-Organ Transplant Unit, Division of General Surgery, Department of Surgery, University Health Network. University of Toronto, Canada; Department of Medicine, University Health Network, University of Toronto, Canada.
3
Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto Canada.
4
Multi-Organ Transplant Unit, Division of General Surgery, Department of Surgery, University Health Network. University of Toronto, Canada; Division of General Surgery, Department of Surgery, University Health Network, University of Toronto, Canada. Electronic address: gonzalo.sapisochin@uhn.ca.
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.