Background: Previous studies examining the Scientific Registry of Transplant Recipients (SRTR) database for liver transplantation (LT) have demonstrated inferior survival for hepatocellular carcinoma (HCC) recipients of donation after cardiac death (DCD) allografts in comparison to recipients of donation after brain death (DBD) allografts. While increased HCC recurrence was postulated as a possible mechanism, no studies have compared HCC recurrence in patients undergoing LT with DBD and DCD allografts.

Methods: Recurrence rates as well as patterns of recurrences were investigated in all patients undergoing DBD and DCD liver transplantation for HCC between the dates of January 2003 and December 2012.

Results: From a total of 293 DCD LT and 1583 DBD LT, 397 patients undergoing LT for HCC(57 DCD and 340 DBD) were identified and compared. No difference in mean tumor number(p=0.26), mean total tumor volume(p=0.34) and mean serum AFP(p=0.47) was seen between the groups. HCC recurrence was identified in 7 (12.3%) patients in the DCD group and 41 (12.1%) of patients in the DBD group. There was no difference in recurrence free-survival(p=0.29) or cumulative incidence of HCC recurrence(p=0.91) between the groups. Liver allograft was the first site of recurrence in 2 (37%) of patients in the DCD group and 22 (65%) of patients in the DBD group(p=0.39). On logistic regression there was no significant association between cold ischemia time(CIT) or donor warm ischemia time(DWIT) and recurrence of HCC.

Conclusion: Patients with HCC undergoing LT with DBD and DCD allografts demonstrated no difference in the rate of HCC recurrence. The present study contains detailed explant pathology information and complete recurrence data that cannot be obtained from larger registry studies. The location of first HCC recurrence was also not significantly different between the groups. Previously published differences in survival demonstrated between recipients with HCC receiving DBD and DCD allografts, despite statistical adjustment, can likely be explained by practice patterns not captured by variables contained in the SRTR database.

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