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Live donor liver offers improve transplant survival in patients with HCC

Patients with hepatocellular carcinoma who had a potential live donor at listing for liver transplantation had a significantly lower risk for mortality compared with those who waited for a deceased donor graft, according to recently published data.

According to Nicolas Goldaracena, MD, from the University of Toronto in Canada, and colleagues, the benefits derived from live donor liver transplantation (LDLT) related to a lower dropout rate and shorter waiting period.

“One of the main concerns when offering LDLT to patients with HCC is the risk of ‘fast-tracking’ patients to transplant and a potential increase in the risk of post-transplant recurrence,” Goldaracena and colleagues wrote. “Previous studies have shown that shorter waiting times may be associated with higher posttransplant recurrence. Our study indicates that waiting times shorter than 9 months are not detrimental. This result is in accordance with others.”

Among 851 patients, 219 had a potential live donor offer and 632 had a potential deceased donor offer. More patients in the live donor group were beyond University of California San Francisco criteria compared with those in the deceased donor group (26% vs. 18.8%; P = .02).

Waitlist time was significantly shorter for patients in the live donor group compared with the deceased donor group (4.8 vs. 6.2 months; P = .02). More patients from the deceased donor group dropped out while on the waitlist (27.5% vs. 14.6%; P < .001).

Survival rates were 86% at 1 year, 82% at 3 years, and 72% at 5 years among patients who received a live donor liver compared with 63% at 1 year, 68% at 3 years, and 57% at 5 years among those who received a deceased donor liver (P = .02).

Multivariate analysis showed that having a live donor available at listing was a protective factor against mortality (HR = 0.67; 95% CI, 0.53-0.86). Waiting times of 9 months to 12 months (HR = 1.53; 95% CI, 1.02-2.31) and more than 12 months (HR = 1.69; 95% CI, 1.23-2.32) correlated with an increased risk for mortality.

Goldaracena and colleagues noted that within the small difference in waiting time (1.4 months), patients with a potential live donor offer had an approximately 50% lower dropout rate. They wrote that this may be because, in Toronto, potential donors are not fully evaluated until the recipient is listed and patients with a live donor are included on the deceased donor waitlist until the living donor’s evaluation is completed or surgery is scheduled.

“Transplant programs around the world should encourage patients with HCC who are listed for LT to consider LDLT, so that they have faster access to transplants and better survival outcomes,” the researchers concluded. – by Talitha Bennett

Disclosure: The authors report no relevant financial disclosures.