Donor Factors Similarly Impact Survival Outcome after LT in HCC and Non-HCC Patients
Internal Medicine, University of Michigan, Ann Arbor, MI
Arbor Research Collaborative for Health, Ann Arbor, MI
Department of Surgery, University of Michigan, Ann Arbor, MI
Meeting: 2013 American Transplant Congress
Abstract number: A699
Introduction: Many have advocated the preferential use of high risk allografts for hepatocellular carcinoma (HCC) patients undergoing liver transplantation (LT). HCC patients tend to have relatively preserved liver function, and their outcome is felt to be driven largely by tumor-related factors. It is believed that they may tolerate a high risk organ better than patients with more advanced liver failure. These assumptions have not been previously tested.
Aim: To compare the relative importance of donor vs. recipient factors on post-OLT survival among HCC and non-HCC recipients.
Methods: The study group included Scientific Registry of Transplant Recipients data on adult recipients of deceased donor liver transplants 2/2002-12/2008. Recipients were classified as HCC based on MELD exception applications and were compared to all other recipients. Exclusions included Status 1, re-LT, or multi-organ transplant. Predictors of post-LT survival were identified by Cox regression. The c-statistic was calculated to determine the contribution of donor and recipient factors to post-LT survival. To test whether donor factors have less impact on survival in HCC patients, interaction terms were created between HCC diagnosis and donor factors.
Results: Of the 40212 DDLTs during the study period, 29020 (72%) met study criteria. A total of 7786 (27%) were transplanted with a diagnosis of HCC. Of these patients, 7249 (93%) met Milan criteria, and 7644 (98%) received MELD exception. The mean lab MELD was 13 in the HCC cohort and 22 in the non-HCC cohort. The mean donor risk index was 1.5 in both cohorts. The 1-year/5-year survival was 88%/68%, and 87%/74%, among HCC and non-HCC recipients, respectively (p<0.0001). On multivariate analysis, there was no statistically significant interaction between HCC diagnosis and DRI (HR 0.94, 95%CI 0.832-1.062, p=0.317). Likewise, no interaction was seen between HCC diagnosis and individual donor factors. In both groups, donor and recipient factors carried similar weight in determining post-LT survival.
| HCC | non-HCC | |
| Full Model | 0.608 | 0.628 |
| Recipient Variables Only | 0.585 | 0.608 |
| Donor Variables Only | 0.570 | 0.570 |
Conclusion: Contrary to previous assumptions, donor factors play a similar role in determining survival post-LT among HCC patients and non-HCC patients.
To cite this abstract in AMA style:
Salgia R, Goodrich N, Beil C, Merion R, Volk M. Donor Factors Similarly Impact Survival Outcome after LT in HCC and Non-HCC Patients [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/donor-factors-similarly-impact-survival-outcome-after-lt-in-hcc-and-non-hcc-patients/. Accessed November 22, 2024.« Back to 2013 American Transplant Congress