INTRODUCTION

The use of partial liver grafts in the context of hepatocellular carcinoma (HCC) remains a matter of

debate because of a supposed higher risk of cancer recurrence compared to that of whole liver

grafting. We present a single center series of 161 adult recipients with HCC who underwent liver

transplantation (LT) over a 13 year period.

METHODS

From december 1998 to july 2010, 161 LT were performed in patients with HCC. Of those, 8 died

during the 3 month period following LT and were excluded from the study. The remaining 153

patients were 125 males and 28 females with a mean age of 56 years. At the time of listing for LT,

29% and 12% of the tumors were radiologically classified Milan and UCSF out respectively. At the

time of transplantation, mean MELD score was 14.

RESULTS

LT were performed by using 39 (25%) partial grafts including 20 split grafts (17 right and 3 left

lobes) and 19 living donor grafts (18 right and 1 left lobes). On explants, HCC was found to be Milan

and UCSF out in 27% and 25% respectively. After a mean follow-up time of 83 months, overall

patient survival was 79% and HCC recurrence rate was 12%. In univariate analysis, there were no

significant differences between whole and partial LT for recipient age and gender, waiting time, MELD

score, pre-LT HCC treatment, HCC stages at the time of listing and on explants and HCC recurrence

(13% versus 5.1%, p=0.17). Nevertheless, donors were significantly younger in the partial graft

group than in the whole liver graft group (28 versus 47 years, p<0.0001) and overall patient survival

was much better in patients who had a partial graft compared to those with whole liver graft (94.9%

versus 73.6%, p=0.005). Overall recurrence-free patient survival was 87.6% ; it was 89.7% and

86.8% in partial and whole LT respectively (p=0.78).

CONCLUSION

In this series, the use of partial liver grafts for transplantation in patients with HCC was not

associated with increased HCC recurrence rate as compared to whole LT. Overall

survivals in patients who had partial LT were better than in those with whole liver

grafting. The role of young donors in this setting deserves further studies.

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