1. Outcomes of Living and Deceased Donor Liver Transplant Recipients With Hepatocellular Carcinoma: Results of the A2ALL Cohort †
- Author
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Kulik, LM, Fisher, RA, Rodrigo, DR, Brown, RS, Freise, CE, Shaked, A, Everhart, JE, Everson, GT, Hong, JC, Hayashi, PH, Berg, CL, Lok, ASF, and Group, the A2ALL Study
- Subjects
Biomedical and Clinical Sciences ,Clinical Sciences ,Liver Cancer ,Hepatitis ,Rare Diseases ,Transplantation ,Organ Transplantation ,Emerging Infectious Diseases ,Infectious Diseases ,Cancer ,Comparative Effectiveness Research ,Chronic Liver Disease and Cirrhosis ,Digestive Diseases ,Liver Disease ,Good Health and Well Being ,Adult ,Cadaver ,Carcinoma ,Hepatocellular ,Cohort Studies ,Female ,Follow-Up Studies ,Graft Rejection ,Graft Survival ,Humans ,Kaplan-Meier Estimate ,Liver Neoplasms ,Liver Transplantation ,Living Donors ,Male ,Middle Aged ,Multivariate Analysis ,Neoplasm Invasiveness ,Neoplasm Recurrence ,Local ,Neoplasm Staging ,Postoperative Complications ,Predictive Value of Tests ,Proportional Hazards Models ,Retrospective Studies ,Risk Assessment ,Survival Rate ,Time Factors ,Treatment Outcome ,HCC ,loco-regional therapy ,MELD score ,Milan criteria ,recurrence ,survival ,A2ALL Study Group ,Medical and Health Sciences ,Surgery ,Clinical sciences ,Immunology - Abstract
Hepatocellular carcinoma (HCC) represents an increasing fraction of liver transplant indications; the role of living donor liver transplant (LDLT) remains unclear. In the Adult-to-Adult Living Donor Liver Transplantation Cohort Study, patients with HCC and an LDLT or deceased donor liver transplant (DDLT) for which at least one potential living donor had been evaluated were compared for recurrence and posttransplant mortality rates. Mortality from date of evaluation of each recipient's first potential living donor was also analyzed. Unadjusted 5-year HCC recurrence was significantly higher after LDLT (38%) than DDLT (11%), (p = 0.0004). After adjustment for tumor characteristics, HCC recurrence remained significantly different between LDLT and DDLT recipients (hazard ratio (HR) = 2.35; p = 0.04) for the overall cohort but not for recipients transplanted following the introduction of MELD prioritization. Five-year posttransplant survival was similar in LDLT and DDLT recipients from time of transplant (HR = 1.32; p = 0.27) and from date of LDLT evaluation (HR = 0.73; p = 0.36). We conclude that the higher recurrence observed after LDLT is likely due to differences in tumor characteristics, pretransplant HCC management and waiting time.
- Published
- 2012