Comparing Post-Transplant Outcomes in Living and Deceased Donor Liver Transplantation for Patients with Hepatocellular Carcinoma: An Analysis of UNOS Registry

T. Kitajima¹, D. Moonka², S. Yeddula¹, M. Rizzari¹, K. Collins¹, A. Yoshida¹, M. S. Abouljoud¹, S. Nagai¹

¹Transplant and Hepatobiliary Surgery, Henry Ford Hospital, Detroit, MI, ²Gastroenterology and Hepatology, Henry Ford Hospital, Detroit, MI

Meeting: 2020 American Transplant Congress

Abstract number: B-159

Keywords: Graft survival, Hepatocellular carcinoma, Liver transplantation, Living donor

Session Information

Session Name: Poster Session B: Liver: Living Donors and Partial Grafts

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Because of possible short waiting time, living donor liver transplantation (LDLT) for HCC may provide survival benefit compared to deceased donor LT (DDLT). This study aimed to compare post-transplant outcomes in HCC patients between LDLT and DDLT.

*Methods: This study used data from UNOS registry and included adult patients listed for LT between 2009 and 2018. Patients who received DDLT with HCC MELD exception (DDLT group, n=13521) and those with HCC who underwent LDLT (LDLT group, n=247) were evaluated. Patients with combined organ transplant and re-transplantation were excluded. Patients who had LDLT in low-volume centers (<20 LDLTs during the study period) were excluded. Graft survival (GS) were compared between the DDLT and LDLT groups.

*Results: Recipient characteristics including PVT, previous surgical history, and MELD score were comparable. In LDLT, 163 (66%) were approved for HCC MELD exception in waitlist. 30-day (97.1% vs 92.6%; p<0.001) and 1-year GS (90.9% vs. 86.4%; p=0.011) were significantly worse in LDLT. Vascular thrombosis (0.7% vs. 2.0%; p=0.026) and HAT (0.4% vs. 2.0%; p=0.004) as a reason for graft loss were more frequently observed in LDLT. Adjusted risk for graft loss was significantly higher in LDLT (30-day; HR 2.96; p<0.001, 1-year; 1.78; p<0.001, Figure 1).

*Conclusions: LDLT showed inferior short-term LT outcomes to DDLT in patients with HCC. Significantly higher risk of 30-day graft loss in LDLT was attributable to vascular complications. When patients are qualified for HCC MELD exception, it may be better to wait for a transplant opportunity using a deceased donor.

To cite this abstract in AMA style:

Kitajima T, Moonka D, Yeddula S, Rizzari M, Collins K, Yoshida A, Abouljoud MS, Nagai S. Comparing Post-Transplant Outcomes in Living and Deceased Donor Liver Transplantation for Patients with Hepatocellular Carcinoma: An Analysis of UNOS Registry [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/comparing-post-transplant-outcomes-in-living-and-deceased-donor-liver-transplantation-for-patients-with-hepatocellular-carcinoma-an-analysis-of-unos-registry/. Accessed May 11, 2025.

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