1 Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. 2 Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea. 3 Address correspondence to: Kwang-Woong Lee, M.D., Department of Surgery, Seoul National University College of Medicine, 101 Daehak-no, Jongno-gu, Seoul 110-744, Korea.
Living-donor liver transplantation (LDLT) is becoming an important tool in hepatocellular carcinoma (HCC) treatment. However, the oncologic outcome between LDLT and deceased-donor LT (DDLT) for HCC remains controversial. This study aims to compare the HCC recurrence rates after LDLT versus DDLT.
Two hundred sixteen patients (166 LDLTs and 50 DDLTs) who underwent LT for HCC within University of California-San Francisco criteria were retrospectively reviewed. LDLT patients were divided into two groups: small living-donor graft (LDG; graft-to-recipient body weight ratio<1.0, n=59) and nonsmall LDG (graft-to-recipient body weight ratio≥1.0, n=107). Patients were further stratified into low- and high-risk settings by the number of risk factors for recurrence.
The recurrence-free survival was lower in LDLT compared with DDLT (88.6% and 80.7% vs. 96.0% and 94.0% at 1 and 5 years; P=0.045). There was no significant difference between two groups regarding the majority of clinical and tumor characteristics, with the exception of a higher proportion of microvascular invasion presence in LDLT. After the adjustment for microvascular invasion, LDLT was identified as an independent risk factor for recurrence. Moreover, recurrence-free survival between small and nonsmall LDG was not statistically significant. In low-risk setting (≤1 risk factor), LDLT showed comparable outcome with DDLT. However, the risk of recurrence was higher in LDLT than DDLT in high-risk patients.
In conclusion, LDLT showed poorer outcome than DDLT. This should be considered to select optimal strategy for HCC.