Liver transplantation for Hepatocellular Carcinoma (HCC) using living donor grafts has been shown to be associated with an increased risk of disease recurrence when compared to whole organ recipients. We aimed to determine the risk of graft failure and patient mortality using living-donor (LD) and deceased-donor (DD) partial grafts in liver transplantation for HCC.

UNOS data from 46,441 first-time adult recipients of liver transplants for HCC (3/2002-12/2010) were analyzed (1,974 LD and 589 DD partial-grafts). Multiorgan-recipients and donors after circulatory death were excluded. Bivariate risk factors (p<0.2) were included in case-mix adjusted-proportional hazards models to examine the effect of graft-type and HCC on graft failure and mortality. Cause of death was non-uniformly reported and therefore not included in the analysis.

LD and DD partial grafts were associated with an increased risk of graft failure (p=.02,p<.001 respectively). DD partial grafts were associated with an increased risk of patient mortality (p<.001) compared to whole grafts in recipients with HCC on donor age-restricted survival analyses (<35y). On multivariate analyses, LD and DD partial grafts were associated with hazard ratios of graft failure of 1.34 (1.02-1.76) and 1.43 (1.05-1.93) respectively compared to whole grafts in recipients with HCC. In patients without HCC, all graft types were associated with comparable outcomes.

Partial liver transplantation for HCC is associated with a disproportionate risk of graft failure. Additional studies are required to determine the cause of increased graft failure in these patients.

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