Living Donor Liver Transplantation Versus Deceased Donor Liver Transplantation for Hepatocellular Carcinoma Within or Beyond the Milan Criteria: Comparable Long-Term Outcomes

• Published in: Transplantation proceedings 2021-01, Vol.53 (1), p.92-97
• Main Authors: Lee, Sunyoung, Song, Gi-Won, Kim, Kyoung Won, Kwon, Jae Hyun, Lee, Sung-Gyu
• Format: Article
• Language: English
• Subjects: Adult; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Female; Humans; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation - methods; Liver Transplantation - mortality; Male; Middle Aged; Retrospective Studies; Tissue Donors - supply & distribution
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2020.10.012

The long-term outcomes after living donor liver transplantation (LDLT) vs deceased donor liver transplantation (DDLT) for hepatocellular carcinoma (HCC) remain controversial. We compared the long-term outcomes between LDLT and DDLT in patients with HCCs within or beyond the Milan criteria. This retrospective study included 896 patients who underwent liver transplantation (829 LDLTs and 67 DDLTs) for HCC from June 2005 to May 2015. Recurrence-free survival (RFS) and overall survival (OS) were estimated using the Kaplan–Meier method with log-rank test. RFS at 1, 3, 5, and 10 years after LDLT was 89.6%, 84.6%, 82.4%, and 79.6%, respectively, and, after DDLT, was 92.4%, 86.2%, 82.4%, and 82.4%, respectively, and OS at 1, 3, 5, and 10 years after LDLT was 96.1%, 88.1%, 85.6%, and 82.7%, respectively, and, after DDLT, was 97.0%, 83.6%, 82.1%, and 77.3%, respectively, with no significant differences in RFS (P = .838) or OS (P = .293) between groups. No statistically significant differences after LDLT or DDLT were identified in RFS (89.8% vs 98.1%, respectively, at 5 years; P = .053) or OS (90.4% vs 90.6% , respectively, at 5 years; P = .583) for HCCs meeting the Milan criteria as well as for those beyond the Milan criteria (RFS, 37.8% vs 28.6%, respectively, at 5 years; P = .560 and OS, 57.3% vs 50.0%, respectively, at 5 years; P = .743). Patients who underwent LDLT for HCCs showed comparable long-term outcomes to patients who underwent DDLT. Patients with HCCs within the Milan criteria demonstrated acceptable long-term outcomes after both LDLT and DDLT. •No statistically significant differences were identified in recurrence-free survival (RFS) or overall survival (OS) rates after living donor liver transplantation (LDLT) or deceased donor liver transplantation (DDLT) in patients with hepatocellular carcinomas (HCCs) within the Milan criteria.•For patients with HCCs beyond the Milan criteria, LDLT and DDLT also demonstrated similar RFS and OS rates.•Patients with HCCs that met pretransplant Milan criteria showed acceptable long-term outcomes after both LDLT and DDLT.