Comparative study of living and deceased donor liver transplantation as a treatment for hepatocellular carcinoma

Mizuki Ninomiya, Ken Shirabe, Marcelo E. Facciuto, Myron E. Schwartz, Sander S. Florman, Tomoharu Yoshizumi, Norifumi Harimoto, Toru Ikegami, Hideaki Uchiyama, Yoshihiko Maehara

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Abstract

Background Living donor liver transplantation (LDLT) is an important treatment option for unresectable hepatocellular carcinoma (HCC), but whether recurrence and survival in LDLT differ from those in deceased donor liver transplantation (DDLT) remains controversial. Study Design A retrospective analysis was performed between patients with HCC who underwent LDLT in a Japanese institute (n = 133) and those who underwent DDLT in a United States institute (n = 362). Results Although there was a difference in patient background characteristics (eg, body mass index, donor age, Model for End-Stage Liver Disease [MELD] score), tumor aggressiveness represented by Milan criteria and microscopic vascular invasion were comparable between the 2 groups. The cumulative 5-year recurrence rates of the LDLT group and the DDLT group were similar (14.8% vs 19.0%, p = 0.638), but overall survival in the LDLT group was significantly better than that in the DDLT group (84.2% vs 63.5%, p < 0.0001). Separate multivariate analysis identified different preoperative predictive factors for HCC recurrence (salvage transplantation and Des-gamma-carboxy prothrombin >300 in the LDLT group, beyond Milan criteria in the DDLT group). Combined multivariate analysis of the 2 groups identified recipient's body mass image >30 kg/m2 as an independent risk factor for overall survival; the technique of transplantation (LDLT or DDLT) was not found to be a risk factor. Conclusions When compared between the institutes where LDLT or DDLT were the first treatment choices for unresectable HCC, recurrence rates were comparable. Living donor liver trasplantation is a viable treatment option for unresectable HCC, providing recurrence rates similar to those achieved with DDLT.

Original languageEnglish
Pages (from-to)297-304.e3
JournalJournal of the American College of Surgeons
Volume220
Issue number3
DOIs
Publication statusPublished - Jan 1 2015

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Living Donors
Liver Transplantation
Hepatocellular Carcinoma
Tissue Donors
Therapeutics
Recurrence
Survival
End Stage Liver Disease
Body Image

All Science Journal Classification (ASJC) codes

  • Surgery

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Comparative study of living and deceased donor liver transplantation as a treatment for hepatocellular carcinoma. / Ninomiya, Mizuki; Shirabe, Ken; Facciuto, Marcelo E.; Schwartz, Myron E.; Florman, Sander S.; Yoshizumi, Tomoharu; Harimoto, Norifumi; Ikegami, Toru; Uchiyama, Hideaki; Maehara, Yoshihiko.

In: Journal of the American College of Surgeons, Vol. 220, No. 3, 01.01.2015, p. 297-304.e3.

Research output: Contribution to journalArticle

Ninomiya, Mizuki ; Shirabe, Ken ; Facciuto, Marcelo E. ; Schwartz, Myron E. ; Florman, Sander S. ; Yoshizumi, Tomoharu ; Harimoto, Norifumi ; Ikegami, Toru ; Uchiyama, Hideaki ; Maehara, Yoshihiko. / Comparative study of living and deceased donor liver transplantation as a treatment for hepatocellular carcinoma. In: Journal of the American College of Surgeons. 2015 ; Vol. 220, No. 3. pp. 297-304.e3.
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abstract = "Background Living donor liver transplantation (LDLT) is an important treatment option for unresectable hepatocellular carcinoma (HCC), but whether recurrence and survival in LDLT differ from those in deceased donor liver transplantation (DDLT) remains controversial. Study Design A retrospective analysis was performed between patients with HCC who underwent LDLT in a Japanese institute (n = 133) and those who underwent DDLT in a United States institute (n = 362). Results Although there was a difference in patient background characteristics (eg, body mass index, donor age, Model for End-Stage Liver Disease [MELD] score), tumor aggressiveness represented by Milan criteria and microscopic vascular invasion were comparable between the 2 groups. The cumulative 5-year recurrence rates of the LDLT group and the DDLT group were similar (14.8{\%} vs 19.0{\%}, p = 0.638), but overall survival in the LDLT group was significantly better than that in the DDLT group (84.2{\%} vs 63.5{\%}, p < 0.0001). Separate multivariate analysis identified different preoperative predictive factors for HCC recurrence (salvage transplantation and Des-gamma-carboxy prothrombin >300 in the LDLT group, beyond Milan criteria in the DDLT group). Combined multivariate analysis of the 2 groups identified recipient's body mass image >30 kg/m2 as an independent risk factor for overall survival; the technique of transplantation (LDLT or DDLT) was not found to be a risk factor. Conclusions When compared between the institutes where LDLT or DDLT were the first treatment choices for unresectable HCC, recurrence rates were comparable. Living donor liver trasplantation is a viable treatment option for unresectable HCC, providing recurrence rates similar to those achieved with DDLT.",
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AU - Ninomiya, Mizuki

AU - Shirabe, Ken

AU - Facciuto, Marcelo E.

AU - Schwartz, Myron E.

AU - Florman, Sander S.

AU - Yoshizumi, Tomoharu

AU - Harimoto, Norifumi

AU - Ikegami, Toru

AU - Uchiyama, Hideaki

AU - Maehara, Yoshihiko

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N2 - Background Living donor liver transplantation (LDLT) is an important treatment option for unresectable hepatocellular carcinoma (HCC), but whether recurrence and survival in LDLT differ from those in deceased donor liver transplantation (DDLT) remains controversial. Study Design A retrospective analysis was performed between patients with HCC who underwent LDLT in a Japanese institute (n = 133) and those who underwent DDLT in a United States institute (n = 362). Results Although there was a difference in patient background characteristics (eg, body mass index, donor age, Model for End-Stage Liver Disease [MELD] score), tumor aggressiveness represented by Milan criteria and microscopic vascular invasion were comparable between the 2 groups. The cumulative 5-year recurrence rates of the LDLT group and the DDLT group were similar (14.8% vs 19.0%, p = 0.638), but overall survival in the LDLT group was significantly better than that in the DDLT group (84.2% vs 63.5%, p < 0.0001). Separate multivariate analysis identified different preoperative predictive factors for HCC recurrence (salvage transplantation and Des-gamma-carboxy prothrombin >300 in the LDLT group, beyond Milan criteria in the DDLT group). Combined multivariate analysis of the 2 groups identified recipient's body mass image >30 kg/m2 as an independent risk factor for overall survival; the technique of transplantation (LDLT or DDLT) was not found to be a risk factor. Conclusions When compared between the institutes where LDLT or DDLT were the first treatment choices for unresectable HCC, recurrence rates were comparable. Living donor liver trasplantation is a viable treatment option for unresectable HCC, providing recurrence rates similar to those achieved with DDLT.

AB - Background Living donor liver transplantation (LDLT) is an important treatment option for unresectable hepatocellular carcinoma (HCC), but whether recurrence and survival in LDLT differ from those in deceased donor liver transplantation (DDLT) remains controversial. Study Design A retrospective analysis was performed between patients with HCC who underwent LDLT in a Japanese institute (n = 133) and those who underwent DDLT in a United States institute (n = 362). Results Although there was a difference in patient background characteristics (eg, body mass index, donor age, Model for End-Stage Liver Disease [MELD] score), tumor aggressiveness represented by Milan criteria and microscopic vascular invasion were comparable between the 2 groups. The cumulative 5-year recurrence rates of the LDLT group and the DDLT group were similar (14.8% vs 19.0%, p = 0.638), but overall survival in the LDLT group was significantly better than that in the DDLT group (84.2% vs 63.5%, p < 0.0001). Separate multivariate analysis identified different preoperative predictive factors for HCC recurrence (salvage transplantation and Des-gamma-carboxy prothrombin >300 in the LDLT group, beyond Milan criteria in the DDLT group). Combined multivariate analysis of the 2 groups identified recipient's body mass image >30 kg/m2 as an independent risk factor for overall survival; the technique of transplantation (LDLT or DDLT) was not found to be a risk factor. Conclusions When compared between the institutes where LDLT or DDLT were the first treatment choices for unresectable HCC, recurrence rates were comparable. Living donor liver trasplantation is a viable treatment option for unresectable HCC, providing recurrence rates similar to those achieved with DDLT.

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