Skip to main content

Donor Factors Similarly Impact Survival Outcome After Liver Transplantation in Hepatocellular Carcinoma and Non-hepatocellular Carcinoma Patients



Many have advocated the preferential use of high risk allografts for hepatocellular carcinoma patients undergoing liver transplantation. Hepatocellular carcinoma (HCC) patients tend to have relatively preserved liver function, and their outcome is felt to be driven largely by tumor-related factors.


The aim of this study was to compare the relative importance of donor versus recipient factors on post-orthotopic liver transplantation survival among HCC and non-HCC recipients.


The study group included Scientific Registry of Transplant Recipients data on adult recipients of deceased donor liver transplants from February 2002 through December 2008. Recipients were classified as HCC based on MELD exception applications and were compared to all other recipients. Predictors of post-LT survival were identified by Cox regression. To test whether donor factors have less impact on survival in HCC patients, interaction terms were created between HCC diagnosis and donor factors.


Of the 40,212 DDLTs during the study period, 29,020 (72 %) met study criteria. A total of 7,786 (27 %) were transplanted with a diagnosis of HCC. The mean donor risk index was 1.5 in both cohorts. The 1-/5-year survival was 88 %/68 % and 87 %/74 % among HCC and non-HCC recipients, respectively (p < 0.0001). On multivariate analysis, there was no statistically significant interaction between HCC diagnosis and DRI (HR 0.94, p = 0.317). Likewise, no interaction was seen between HCC diagnosis and individual donor factors. In both groups, donor and recipient factors carried similar weight in determining post-LT survival.


Contrary to previous assumptions, donor factors play a similar role in determining survival post-LT among HCC patients and non-HCC patients.

This is a preview of subscription content, access via your institution.

Fig. 1


  1. El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011;365:1118–1127.

    CAS  PubMed  Article  Google Scholar 

  2. Bosch FX, Ribes J, Diaz M, et al. Primary liver cancer: worldwide incidence and trends. Gastroenterology. 2004;127:S5–S16.

    PubMed  Article  Google Scholar 

  3. Llovet JM, Schwartz M, Mazzaferro V. Resection and liver transplantation for hepatocellular carcinoma. Semin Liver Dis. 2005;25:181–200.

    PubMed  Article  Google Scholar 

  4. Pelletier SJ, Fu S, Thyagarajan V, et al. An intention-to-treat analysis of liver transplantation for hepatocellular carcinoma using organ procurement transplant network data. Liver Transpl. 2009;15:859–868.

    PubMed  Article  Google Scholar 

  5. Zavaglia C, De Carlis L, Alberti AB, et al. Predictors of long-term survival after liver transplantation for hepatocellular carcinoma. Am J Gastroenterol. 2005;100:2708–2716.

    PubMed  Article  Google Scholar 

  6. Bertuzzo VR, Cescon M, Ravaioli M, et al. Analysis of factors affecting recurrence of hepatocellular carcinoma after liver transplantation with a special focus on inflammation markers. Transplantation. 2011;91:1279–1285.

    PubMed  Article  Google Scholar 

  7. Jonas S, Bechstein WO, Steinmuller T, et al. Vascular invasion and histopathologic grading determine outcome after liver transplantation for hepatocellular carcinoma in cirrhosis. Hepatology. 2001;33:1080–1086.

    CAS  PubMed  Article  Google Scholar 

  8. Ioannou GN, Perkins JD, Carithers RL. Liver transplantation for hepatocellular carcinoma: impact of the MELD allocation system and predictors of survival. Gastroenterology. 2008;134:1342–1351.

    PubMed  Article  Google Scholar 

  9. Saab S, Wang V, Ibrahim AB, et al. MELD score predicts 1-year patient survival post-orthotopic liver transplantation. Liver Transpl. 2003;9:473–476.

    PubMed  Article  Google Scholar 

  10. Feng S, Goodrich NP, Bragg-Gresham JL, et al. Characteristics associated with liver graft failure: the concept of a donor risk index. Am J Transplant. 2006;6:783–790.

    CAS  PubMed  Article  Google Scholar 

  11. Angelico M, Cillo U, Fagiuoli S, et al. Liver match, a prospective observational cohort study on liver transplantation in Italy: study design and current practice of donor-recipient matching. Dig Liver Dis. 2011;43:155–164.

    PubMed  Article  Google Scholar 

  12. El-Serag HB, Marrero JA, Rudolph L, Reddy KR. Diagnosis and treatment of hepatocellular carcinoma. Gastroenterology. 2008;134:1752–1763.

    PubMed  Article  Google Scholar 

  13. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–699.

    CAS  PubMed  Article  Google Scholar 

  14. Volk ML, Reichert HA, Lok ASF, et al. Variation in organ quality between liver transplant centers. Am J Transplant. 2011;11:958–964.

    CAS  PubMed Central  PubMed  Article  Google Scholar 

  15. Washburn K, Edwards E, Harper A, et al. Hepatocellular carcinoma patients are advantaged in the current liver transplant allocation system. Am J Transplant. 2010;10:1643–1648.

    CAS  PubMed  Article  Google Scholar 

Download references

Conflict of interest


Author information

Authors and Affiliations


Corresponding author

Correspondence to Reena J. Salgia.

Rights and permissions

Reprints and Permissions

About this article

Cite this article

Salgia, R.J., Goodrich, N.P., Marrero, J.A. et al. Donor Factors Similarly Impact Survival Outcome After Liver Transplantation in Hepatocellular Carcinoma and Non-hepatocellular Carcinoma Patients. Dig Dis Sci 59, 214–219 (2014).

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI:


  • Liver transplant
  • Donor factors
  • Hepatocellular carcinoma
  • Survival