Liver transplantation for hepatocellular carcinoma using grafts from uncontrolled circulatory death donation

Abstract

Controversy exists regarding whether the rate of hepatocellular carcinoma (HCC) recurrence after orthotopic liver transplantation (OLT) differs when using livers from donation after controlled circulatory death (DCD) versus livers from donation after brain death (DBD). The aim of this cohort study was to analyze rates of HCC recurrence, patient survival, and graft survival after OLT for HCC, comparing recipients of DBD livers (n = 103) with recipients of uncontrolled DCD livers (uDCD; n = 41). No significant differences in tumor size, tumor number, serum alpha-fetoprotein, proportion of patients within Milan criteria, or pre-OLT bridging therapies were identified between groups, although the waitlist period was significantly shorter in the uDCD group (p = 0.040). HCC recurrence was similar between groups. Patient survival was similar between groups, but graft survival was lower in the uDCD group. Multivariate analysis identified recipient age (p = 0.031), pre-OLT bridging therapy (p = 0.024), and HCC recurrence (p = 0.048) as independent risk factors for patient survival and pre-OLT transarterial chemoembolization (p = 0.045) as the single risk factor for HCC recurrence. In conclusion, similar patient survival and lower graft survival were observed in the uDCD group. However, the use of uDCD livers appears to be justified due to a shorter waitlist time, and lower waitlist dropout and HCC recurrence rates.

Figure 1

(A) Patient survival: 1-, 3- and 5-year were 85%, 78% and 72%, respectively, in DBD recipients and 72%, 65% and 61%, respectively, in uDCD recipients (p = 0.249). (B) Graft survival: 1-, 3- and 5-year were 84%, 77%, and 71%, respectively, in DBD recipients and 65%, 58% and 58%, respectively, in uDCD recipients (p = 0.021). (C) Recurrence-free tumor survival: 1-, 3- and 5-year were 98%, 95% and 82%, respectively, in DBD recipients, and 91%, 79% and 79%, respectively, in uDCD recipients (p = 0.754).