Inferior survival in liver transplant recipients with hepatocellular carcinoma receiving donation after cardiac death liver allografts

Croome, Kris P.; Wall, William; Chandok, Natasha; Beck, Gavin; Marotta, Paul; Hernandez‐Alejandro, Roberto

doi:10.1002/lt.23715

Cited by 60 publications

(63 citation statements)

References 28 publications

(63 reference statements)

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“…1 We agree with the authors that there are no hepatocellular carcinoma (HCC) recurrence data in the Scientific Registry of Transplant Recipients database; therefore, it was not possible to demonstrate that this was the cause of inferior survival observed in the HCC-donation after cardiac death (DCD) group. Although we gave early recurrence as a possible explanation for this inferior survival, we also discussed the idea that the use of DCD organs in patients with HCC may be a practice pattern used for patients who are felt to have greater factors for adverse risk.…”

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confidence: 53%

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Croome

Hernandez‐Alejandro²

2014

Liver Transpl

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supporting

confidence: 53%

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Croome

Hernandez‐Alejandro²

2014

Liver Transpl

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“…One previous study suggests an interaction between HCC and receiving a DCD allograft that leads to inferior survival. 24 However, the study is plagued by the limitations of registry-based data and absence of HCC recurrence data. Even though the authors provide an important observation, they are left to speculate on the reasons for the poorer outcomes for recipients with an HCC diagnosis when DCD allografts are used.…”

Section: Discussionmentioning

confidence: 99%

Early allograft dysfunction in liver transplantation using donation after cardiac death donors results in inferior survival

et al. 2014

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Donation after cardiac death (DCD) liver allografts have been associated with increased morbidity from primary nonfunction, biliary complications, early allograft failure, cost, and mortality. Early allograft dysfunction (EAD) after liver transplantation has been found to be associated with inferior patient and graft survival. In a cohort of 205 consecutive liver-only transplant patients with allografts from DCD donors at a single center, the incidence of EAD was found to be 39.5%. The patient survival rates for those with no EAD and those with EAD at 1, 3, and 5 years were 97% and 89%, 79% and 79%, and 61% and 54%, respectively (P 5 0.009). Allograft survival rates for recipients with no EAD and those with EAD at 1, 3, and 5 years were 90% and 75%, 72% and 64%, and 53% and 43%, respectively (P 5 0.003). A multivariate analysis demonstrated a significant association between the development of EAD and the cold ischemia time [odds ratio (OR) 5 1.26, 95% confidence interval (CI) 5 1.01-1.56, P 5 0.037] and hepatocellular cancer as a secondary diagnosis in recipients (OR 5 2.26, 95% CI 5 1.11-4.58, P 5 0.025). There was no correlation between EAD and the development of ischemic cholangiopathy. In conclusion, EAD results in inferior patient and graft survival in recipients of DCD liver allografts. Understanding the events that cause EAD and developing preventive or early therapeutic approaches should be the focus of future investigations. Liver Transpl 20:1447-1453, 2014. V C 2014 AASLD.Received March 28, 2014; accepted August 7, 2014.The success of liver transplantation (LT) has expanded its therapeutic utility and necessitated the increased use of marginal donors to meet the growing demand. To understand the impact of these marginal organs, a clinical tool for identifying early allograft dysfunction (EAD) has been previously described by multiple groups. 1-4 A simple definition (characterized by high early aminotransferase levels, persistent cholestasis, and prolonged coagulopathy in the first week after LT) has previously been validated in a multicenter retrospective review of 297 LT recipients of liver allografts from both donation after brain death (DBD) and donation after cardiac death (DCD) donors. 5 This clinical tool has served as a marker for an increased risk of mortality, morbidity, allograft failure, and cost. 6 EAD has also become a target for therapeutic intervention to reduce morbidity and mortality in LT. [7][8][9] To date, there has been no published study delineating the incidence of and risk factors for EAD specifically in the recipients of liver allografts from DCD donors.Liver allografts from DCD donors are considered inferior because of an overall increased rate of allograft failure. [10][11][12] For this type of donor, the declaration of death is based on cardiopulmonary criteria

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“…To date, utilization of DCD allografts in patients with HCC has not been examined extensively. One previously published paper examining the data from the SRTR database suggested that even after adjustments for the inherent inferiority observed in DCD allografts as well as other known risk factors, there was an inferior survival for HCC recipients of DCD allografts versus recipients of DBD allografts (8). Early HCC recurrence in the DCD group was postulated as one potential explanation for the observed difference in survival between the DCD and DBD groups.…”

Section: Discussionmentioning

confidence: 99%

“…Survival difference remained even after adjustments for the inherent inferiority observed in DCD allografts as well as other known risk factors (8). While it was postulated that the difference in survival could reflect an increased rate in the recurrence of HCC, the SRTR database does not contain specific data related to recurrence.…”

Section: Introductionmentioning

confidence: 99%

The Use of Donation After Cardiac Death Allografts Does Not Increase Recurrence of Hepatocellular Carcinoma

Croome

Lee

Burns

et al. 2015

American Journal of Transplantation

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Hepatocellular carcinoma (HCC) recurrence in patients undergoing liver transplantation (LT) with donation after brain death (DBD) and donation after cardiac death (DCD) allografts has not previously been investigated. Rates and patterns of HCC recurrences were investigated in patients undergoing DBD (N ¼ 1633) and DCD (N ¼ 243) LT between 2003 and 2012. LT for HCC was identified in 397 patients (340 DBD and 57 DCD). No difference in tumor number (p ¼ 0.26), tumor volume (p ¼ 0.34) and serum alphafetoprotein (AFP) (p ¼ 0.47) was seen between the groups. HCC recurrence was identified in 41 (12.1%) patients in the DBD group and 7 (12.3%) patients in the DCD group. There was no difference in recurrence-free survival (p ¼ 0.29) or cumulative incidence of HCC recurrence (p ¼ 0.91) between the groups. Liver allograft was the first site of recurrence in 22 (65%) patients in the DBD group and two (37%) patients in the DCD group (p ¼ 0.39). LT for HCC with DBD and DCD allografts demonstrate no difference in the rate of HCC recurrence. Previously published differences in survival demonstrated between recipients with HCC receiving DBD and DCD allografts despite statistical adjustment can likely be explained by practice patterns not captured by variables contained in the SRTR database.

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Inferior survival in liver transplant recipients with hepatocellular carcinoma receiving donation after cardiac death liver allografts

Cited by 60 publications

References 28 publications

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Early allograft dysfunction in liver transplantation using donation after cardiac death donors results in inferior survival

The Use of Donation After Cardiac Death Allografts Does Not Increase Recurrence of Hepatocellular Carcinoma

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