Advertisement

Long-Term Survival Outcome Between Living Donor and Deceased Donor Liver Transplant for Hepatocellular Carcinoma: Intention-to-Treat and Propensity Score Matching Analyses

  • Tiffany C. L. Wong
  • Kelvin K. C. NgEmail author
  • James Y. Y. Fung
  • Albert A. C. Chan
  • Tan-To Cheung
  • Kenneth S. H. Chok
  • Jeff W. C. Dai
  • Chung-Mau Lo
Hepatobiliary Tumors
  • 12 Downloads

Abstract

Background

Previous studies comparing outcomes of hepatocellular carcinoma (HCC) patients after living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) showed conflicting results, and most studies measured survival outcomes from the time of liver transplantation (LT).

Method

This retrospective study was aimed to evaluate the long-term outcomes of HCC patients listed for LT using intention-to-treat (ITT) and propensity score matching (PSM) analyses. Clinicopathological data were retrieved from a prospectively collected database.

Results

From 1995 to 2014, 375 HCC patients were listed for LT. ITT-LDLT group had 188 patients, whereas ITT-DDLT group had 187 patients. Twenty-seven patients (14.4%) and 122 patients (65.2%) were delisted from LDLT and DDLT waitlist, respectively. The 1-, 3- and 5-year overall survival rates were significantly better in ITT-LDLT group than ITT-DDLT group (94.1 vs. 77.5%, 81.4 vs. 48.7% and 75.9 vs. 40.8%). High alphafetoprotein (AFP) and ITT-DDLT treatment arm were independent poor prognostic factors affecting overall survival. LDLT group (n = 161) had more young patients, poorer liver function, higher AFP, more tumors outside Milan/UCSF criteria, when compared with DDLT group (n = 85). After PSM, the 1-, 3- and 5-year overall (95.4 vs. 98.5%, 80.0 vs. 92.3% and 73.4 vs. 84.4%) and recurrence-free (87.7% vs. 90.8%, 76.9% vs. 83.1% and 72.2% vs. 81.5%) survival rates were comparable between the matched LDLT and the matched DDLT group, respectively.

Conclusion

Survival benefit of LDLT was observed for HCC patients with ITT analysis. Despite a more advanced tumor stage, overall and recurrence-free survival rates were comparable between LDLT and DDLT using PSM analysis.

Notes

DISCLOSURE

The authors declare that they have no conflict of interest.

Supplementary material

10434_2019_7206_MOESM1_ESM.docx (20 kb)
Supplementary material 1 (DOCX 20 kb)

References

  1. 1.
    O’Grady J, Polson R, Rolles K, Calne R, Williams R. Liver transplantation for malignant disease. Results of 93 consecutive patients. Ann Surg. 1988;207(4):373–9.CrossRefGoogle Scholar
  2. 2.
    Ringe B, Wittekind C, Bechstein W, Bunzendahl H, Pichlmayr R. The role of liver transplantation in hepatobiliary malignancy: a retrospective analysis of 95 patients with particular regard to tumor stage and recurrence. Ann Surg. 1989;209(1):88–98.CrossRefGoogle Scholar
  3. 3.
    Olthoff K, Millis J, Rosove M, Goldstein L, Ramming K, Busuttil R. Is liver transplantation justified for the treatment of hepatic malignancies? Arch Surg. 1990;125(10):1261–6.CrossRefGoogle Scholar
  4. 4.
    Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334(11):693-9.CrossRefGoogle Scholar
  5. 5.
    Vakili K PJ, Cheah YL, Akoad M, Lewis WD, Khettry U, Gordon F, Khwaja K, Jenkins R, Pomfret EA. Living donor liver transplantation for hepatocellular carcinoma: Increased recurrence but improved survival. Liver Transpl. 2009;15(12):1861-6.CrossRefGoogle Scholar
  6. 6.
    Kulik LM FR, Rodrigo DR, Brown RS Jr, Freise CE, Shaked A, Everhart JE, Everson GT, Hong JC, Hayashi PH, Berg CL, Lok AS; A2ALL Study Group. Outcomes of living and deceased donor liver transplant recipients with hepatocellular carcinoma: results of the A2ALL cohort. Am J Transpl. 2012;12(11):2997-3007.CrossRefGoogle Scholar
  7. 7.
    Park MS LK, Suh SW, You T, Choi Y, Kim H, Hong G, Yi NJ, Kwon CH, Joh JW, Lee SK, Suh KS. Living-donor liver transplantation associated with higher incidence of hepatocellular carcinoma recurrence than deceased-donor liver transplantation. Transplantation. 2014;97(1):71-7.CrossRefGoogle Scholar
  8. 8.
    Hwang S, Lee S, Joh J, Suh K, Kim D. Liver transplantation for adult patients with hepatocellular carcinoma in Korea: comparison between cadaveric donor and living donor liver transplantations. Liver Transpl. 2005;11(10):1265-72.CrossRefGoogle Scholar
  9. 9.
    Sotiropoulos GC LH, Nadalin S, Neuhäuser M, Molmenti EP, Baba HA, Paul A, Saner FH, Weber F, Hilgard P, Frilling A, Broelsch CE, Malagó M. Liver transplantation for hepatocellular carcinoma: University Hospital Essen experience and metaanalysis of prognostic factors. J Am Coll Surg. 2007;205(5):661-75.CrossRefGoogle Scholar
  10. 10.
    Di Sandro S, Slim A, Giacomoni A, Lauterio A, Mangoni I, Aseni P, et al. Living donor liver transplantation for hepatocellular carcinoma: long-term results compared with deceased donor liver transplantation. Transpl Proc. 2009;41(4):1283-5.CrossRefGoogle Scholar
  11. 11.
    Sandhu L SC, Guba M, Selzner M, Ghanekar A, Cattral MS, McGilvray ID, Levy G, Greig PD, Renner EL, Grant DR. Living donor liver transplantation versus deceased donor liver transplantation for hepatocellular carcinoma: comparable survival and recurrence. Liver Transpl. 2012;18(3):315-22.CrossRefGoogle Scholar
  12. 12.
    Bhangui P, Vibert E, Majno P, Salloum C, Andreani P, Zocrato J, et al. Intention-to-treat analysis of liver transplantation for hepatocellular carcinoma: living versus deceased donor transplantation. Hepatology. 2011;53(5):1570-9.CrossRefGoogle Scholar
  13. 13.
    Azoulay D, Audureau E, Bhangui P, Belghiti J, Boillot O, Andreani P, et al. Living or brain-dead donor liver transplantation for hepatocellular carcinoma: a multicenter, Western, Intent-to-treat Cohort Study. Ann Surg. 2017;266(6):1035-44.CrossRefGoogle Scholar
  14. 14.
    Lo C, Fan S, Liu C, Chan S, Ng I, Wong J. Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma. Br J Surg. 2007;94(1):78-86.CrossRefGoogle Scholar
  15. 15.
    Lo CM, Fan ST, Liu CL, Chan SC, Wong J. The role and limitation of living donor liver transplantation for hepatocellular carcinoma. Liver Transpl. 2004;10(3):440-7.CrossRefGoogle Scholar
  16. 16.
    Bruix J, Sherman M. American Association for the study of liver diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011;53(3):1020-2.CrossRefGoogle Scholar
  17. 17.
    Fan ST, Lo CM, Poon RT, Yeung C, Leung Liu C, Yuen WK, et al. Continuous improvement of survival outcomes of resection of hepatocellular carcinoma: a 20-year experience. Ann Surg. 2011;253(4):745-58.CrossRefGoogle Scholar
  18. 18.
    Yao F, Ferrell L, Bass N, Watson J, Bacchetti P, Venook A, et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology. 2001;33(6):1394-403.CrossRefGoogle Scholar
  19. 19.
    Wiesner RH, McDiarmid SV, Kamath PS, Edwards EB, Malinchoc M, Kremers WK, et al. MELD and PELD: application of survival models to liver allocation. Liver Transpl. 2001;7(7):567-80.CrossRefGoogle Scholar
  20. 20.
    Chan SC, Sharr WW, Chok KS, Chan AC, Lo CM. Wait and transplant for stage 2 hepatocellular carcinoma with deceased-donor liver grafts. Transplantation. 2013;96(11):995-9.CrossRefGoogle Scholar
  21. 21.
    Urata K, Kawasaki S, Matsunami H, Hashikura Y, Ikegami T, Ishizone S, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology. 1995;21(5):1317-21.CrossRefGoogle Scholar
  22. 22.
    Rubin DB. Propensity score methods. Am J Ophthalmol. 2010;149(1):7-9.CrossRefGoogle Scholar
  23. 23.
    Sheetz KH, Derstine B, Englesbe MJ. Propensity scores for comparative effectiveness research: finding the right match. Surgery. 2016;160(6):1425-6.CrossRefGoogle Scholar
  24. 24.
    24. Pomfret EA, Lodge JP, Villamil FG, Siegler M. Should we use living donor grafts for patients with hepatocellular carcinoma? Ethical considerations. Liver Transpl. 2011;17 Suppl 2:S128-32.CrossRefGoogle Scholar
  25. 25.
    Sapisochin G, Bruix J. Liver transplantation for hepatocellular carcinoma: outcomes and novel surgical approaches. Nat Rev Gastroenterol Hepatol. 2017;14(4):203-17.CrossRefGoogle Scholar
  26. 26.
    de Villa V, Lo CM. Liver transplantation for hepatocellular carcinoma in Asia. Oncologist. 2007;12(11):1321-31.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2019

Authors and Affiliations

  • Tiffany C. L. Wong
    • 1
    • 2
    • 3
  • Kelvin K. C. Ng
    • 3
    Email author
  • James Y. Y. Fung
    • 4
    • 5
  • Albert A. C. Chan
    • 1
    • 2
    • 3
  • Tan-To Cheung
    • 1
    • 2
    • 3
  • Kenneth S. H. Chok
    • 1
    • 2
    • 3
  • Jeff W. C. Dai
    • 1
    • 2
  • Chung-Mau Lo
    • 1
    • 2
    • 3
  1. 1.Department of SurgeryThe University of Hong KongHong KongChina
  2. 2.Department of SurgeryQueen Mary HospitalHong KongChina
  3. 3.Department of SurgeryThe University of Hong Kong-Shenzhen HospitalShenzhenChina
  4. 4.Department of MedicineThe University of Hong KongHong KongChina
  5. 5.Department of MedicineQueen Mary HospitalHong KongChina

Personalised recommendations