Living Donor Liver Transplantation (LDLT) for Hepatocellular Carcinoma (HCC) within and Outside Traditional Selection Criteria: A Multicentric North American Experience
Recommended Citation
Ivanics T, Claasen MP, Samstein B, Emond JC, Fox AN, Pomfret E, Pomposelli J, Tabrizian P, Florman SS, Mehta N, Roberts JP, Emamaullee JA, Genyk Y, Hernandez-Alejandro R, Tomiyama K, Sasaki K, Quintini C, Nagai S, Abouljoud M, Olthoff KM, Hoteit MA, Heimbach J, Taner T, Liapakis AH, Mulligan DC, Sapisochin G, and Halazun KJ. Living Donor Liver Transplantation (LDLT) for Hepatocellular Carcinoma (HCC) within and Outside Traditional Selection Criteria: A Multicentric North American Experience. Ann Surg 2023.
Document Type
Article
Publication Date
7-31-2023
Publication Title
Annals of surgery
Abstract
OBJECTIVE: We evaluated long-term oncologic outcomes of patients post-LDLT within and outside standard transplant selection criteria and the added value of the incorporation of the New York-California (NYCA) score.
SUMMARY BACKGROUND DATA: LDLT offers an opportunity to decrease the liver transplant waitlist, reduce waitlist mortality and expand selection criteria for patients with HCC.
METHODS: Primary adult LDLT recipients between Oct-1999 and Aug-2019 were identified from a multicenter cohort of twelve North American centers. Post-transplant and recurrence-free survival were evaluated using the Kaplan-Meier method.
RESULTS: Three-hundred-and-sixty LDLTs were identified. Patients within Milan criteria (MC) at transplant had a 1-,5-, and 10-year post-transplant survival of 90.9%,78.5%, and 64.1% vs. outside MC 90.4%,68.6%, and 57.7%(P=0.20). For patients within the UCSF criteria, respective post-transplant survival was 90.6%,77.8%, and 65.0%, vs. outside UCSF 92.1%,63.8%, and 45.8%(P=0.08). Fifty-three (83%) patients classified as outside MC at transplant would have been classified as either low- or acceptable risk with the NYCA score. These patients had a 5-year OS of 72.2%. Similarly, 28(80%) patients classified as outside UCSF at transplant would have been classified as low- or acceptable risk with a 5-year OS of 65.3%.
CONCLUSIONS: Long-term survival is excellent for patients with HCC undergoing LDLT within and outside selection criteria, exceeding the minimum recommended 5-years rate of 60% proposed by consensus guidelines. The NYCA categorization offers insight into identifying a substantial proportion of patients with HCC outside the MC and the UCSF criteria who still achieve similar post-LDLT outcomes as patients within the criteria.
PubMed ID
37522174
ePublication
ePub ahead of print
