Introduction

Living donor liver transplantation (LDLT) can reduce waiting times and potentially decrease drop-out rates for cirrhotic patients with HCC. However, it has also been reported to be associated with higher recurrence rate. To elucidate the true benefit of LDLT, we conducted an intention-to-treat (ITT) analysis comparing LDLT to deceased donor liver transplantation (DDLT).

Material & Methods

All patients included in the waiting list with an HCC were included in the study. Patients with tumors found incidentally at explant were excluded. Patients with a potential living donor (donor was ABO compatible and a positive health questionnaire) were included in the LDLT group. Patients without a potential LD were included in the DDLT arm. Patient survival was calculated from the time of listing and from the time of LT. The median follow-up from the time of listing was 48.4 (19.4-95.3) months.

Results

Between January 2000 and December 2014, 664 adult patients with HCC were listed for LT at our center. Of these 119 (17.9%) were included in the LDLT group and 545 (82.1%) in the DDLT group. At listing, the tumor characteristics were similar between groups; ~40% of the cases were outside Milan criteria in both groups. The median time in the waiting list was 8.8 (IQR 6.3-15) in the LDLT compared to 15.5 (IQR 7-29.7) in the DDLT group, p<0.001. The drop-out rate was 10.9% in the LDLT group vs. 20.4% in the DDLT group, p=0.02. The cause of drop-out was tumor progression in most cases; 100% in the LDLT group vs. 82% in the DDLT group. Finally, 106 patients were transplanted with a LD and 434 with a deceased donor graft. The 1-, 3- and 5-years actuarial survival on an ITT basis was 86%, 74%, 68% in the LDLT group vs. 84%, 67%, 59% in the DDLT group, p=0.07. The recurrence rate was similar between groups (16% LDLT group vs. 18.9% DDLT group, p=0.6). The 1-, 3- and 5-years actuarial survival after LT was 94%, 81%, 70% LDLT group vs. 91%, 79%, 75% DDLT group, p=0.5.

Conclusion

LDLT for HCC has comparable post-transplant outcomes to DDLT with a lower drop-out rate. A shorter waiting time in this population does not seem to impact in post-transplant outcomes.

CITATION INFORMATION: Tomiyama K, Goldaracena N, Barbas A, Dib M, Levy G, Lilly L, Ghanekar A, McGilvray I, Renner E, Bhat M, Selzner M, Cattral M, Selzner N, Greig P, Grant D, Sapisochin G. A Comparative Intention-to-Treat Analysis of Liver Transplantation for HCC – Living Donor Liver Transplant vs. Deceased Donor Liver Transplant. Am J Transplant. 2016;16 (suppl 3).

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