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Older donor age, nonlocal distribution potentially increase HCC recurrence after liver transplant
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Liver transplant recipients were at increased risk for hepatocellular carcinoma recurrence if they received a liver from a donor aged at least 60 years or from a nonlocal share distribution, according to study data.
“Liver transplantation for HCC is performed to achieve an oncologic ‘cure’ for candidates with liver disease presenting with unresectable HCC,” Parsia A. Vagefi, MD, FACS, associate surgical director of liver transplantation and surgical director of living donor liver transplantation at Massachusetts General Hospital, told Healio.com/Hepatology. “Indeed, we have achieved excellent results for HCC candidates through the careful and thoughtful selection of candidates and by identifying transplant candidate factors, which portend a higher rate of posttransplant recurrence. However, despite using stringent recipient selection criteria, there still remains a subset of recipients who go on to develop HCC recurrence posttransplant. Our study sought to identify potential donor derived factors that may lead to posttransplant recurrence.”
Parsia A. Vagefi
Vagefi and colleagues analyzed data of adult liver transplant recipients with HCC from the United Network for Organ Sharing database, who underwent transplantation between 2006 and September 2010. The goal was to determine the incidence rate for posttransplant HCC recurrence by donor factors.
Overall, 324 transplant recipients experienced recurrence posttransplant. In donors aged at least 60 years, incidence for HCC recurrence within 4 years posttransplant was greater compared with recipients younger than 60 years (11.8% vs. 7.3%; P < .001). In addition, donors from nonlocal share distribution had a higher 4-year incidence recurrence rate compared with donors within a local share distribution (10.6% vs. 7.4%; P = .004).
After adjusting for clinical characteristics, multivariate analysis showed that transplant recipients had a 70% increased risk for HCC recurrence if they received a liver from a donor aged at least 60 years (P < . 001) and a 42% increased risk for HCC recurrence if received a liver from nonlocal share distribution (P = .009).
“We demonstrated that recipients of donors’ livers 60 years old [or older] and donors from nonlocal share distribution resulted in a higher cumulative incidence of recurrence within 4 years of liver transplantation,” Vagefi said. “Thus, consideration of certain donor-derived factors, much like the current consideration of recipient factors, may help to continue to reduce the overall cumulative incidence of posttransplant HCC recurrence and, thus, improve long-term survival after liver transplantation.” – by Melinda Stevens
Disclosure: The researchers report no relevant financial disclosures.
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