Background: Recent data suggests that patients with Hepatocellular carcinoma (HCC) who receive a donation after cardiac death (DCD) graft have inferior graft and patient survival compared to patients with HCC receiving a donation after brain death (DBD) graft. We aimed to determine the causes for this discrepancy in outcomes.

Methods: Outcomes of 11 patients with HCC who received a DCD liver graft at our institution between 2006 and 2013 (HCC-DCD) were compared to those of a control group of 33 patients with HCC who received a DBD graft (HCC-DBD). Both groups were matched for age, gender, BMI and etiology of liver disease. Patient and graft survival rates for HCC-DCD patients were also compared to those of 50 patients without HCC who received a DCD organ (non HCC-DCD group) during the same time period.

Results: Baseline characteristics including tumor stage were similar between patients in the HCC-DCD and HCC-DBD groups. There was no significant difference in perioperative transfusion requirements or length of ICU stay and mechanical ventilation. There was also no significant difference in the incidence of rejection, hepatic artery thrombosis, infections requiring hospitalization and cardiovascular events between both groups. Graft survival rates were also similar between both groups. Biliary complications (bile leaks, anastomotic and non-anastomotic strictures)occurred in 45% of HCC-DCD patients vs.12% of HCC-DBD patients (p=0.02; OR=6 [1.24-29]). HCC recurred in 0 patients in the HCC-DCD group and 3(9%) in the HCC-DBD group (p=0.4). Patient survival was similar between both groups [figure 1]. There was also no significant difference in patient or graft survival between patients in the HCC-DCD and non HCC-DCD groups.

Conclusion:Patients with HCC who received a DCD liver had more biliary complications compared to patients with HCC receiving a DBD liver however this did not impact graft and patient survival. No difference in HCC recurrence rates was observed.

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