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Liver allografts donated after cardiac death reduced survival in transplant recipients with HCC
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Patient and graft survival among liver transplant recipients with hepatocellular carcinoma were poorer with the use of donation after cardiac death allografts in a recent study.
Researchers evaluated data collected from the Scientific Registry of Transplant Recipients between Jan. 1, 1995 and Oct. 31, 2011. Assessed patients underwent deceased-donor liver transplantation, including 5,638 with hepatocellular carcinoma (HCC) who received donation after brain death (DBD) allografts, 68,651 without HCC who received DBD allografts, 242 with HCC who received donation following cardiac death (DCD) allografts and 2,117 without HCC who received DCD allografts.
Among DCD recipients, those with HCC were significantly older, had lower MELD scores and were less likely to be infected with HCV. Among HCC patients, DCD allograft recipients were significantly older and had lower MELD scores than DBD recipients. Mean tumor number, total volume and serum AFP levels were similar between DBD and DCD recipients.
Multivariate analysis indicated that factors including HCC diagnosis (HR=1.27; 95% CI, 1.05-1.53), DCD allograft (HR=1.7; 95% CI, 1.4-2.05), HCV positivity (HR=1.439; 95% CI, 1.27-1.53), patient age (HR=1.012; 95% CI, 1.006-1.017) and donor age (HR=1.015; 95% CI, 1.012-1.017), MELD score (HR=1.014; 95% CI, 1.008-1.021), race other than black (HR=1.148; 95% CI, 1.03-1.28) and AFP above 400 ng/mL (HR=1.659; 95% CI, 1.461-1.884) were predictive of patient and graft survival. A DCD allograft/HCC diagnosis interaction term developed to assess poorer survival among DCD graft recipients with HCC also was significant (P=.0493).
Subgroup analysis of patients with HCC who received DCD allografts indicated a trend toward improved survival among patients with donor warm ischemia time (WIT) of 15 minutes or shorter, and improved survival among those with cold ischemia time (CIT) of 380 minutes or shorter (P<.036 vs. CIT above 380 minutes).
“This study demonstrates inferior survival for HCC patients receiving DCD allografts vs. those receiving DBD allografts,” the researchers concluded. “It also demonstrates a trend of inferior survival for HCC-DCD patients with prolonged WITs and statistically significant inferior survival for patients with prolonged CITs.”
Disclosure: The researchers report no relevant financial disclosures.