Living vs. deceased donor liver transplantation for hepatocellular carcinoma: a systematic review and meta‐analysis

Abstract

Experimental studies suggest that the regenerating liver provides a "fertile field" for the growth of hepatocellular carcinoma (HCC). However, clinical studies report conflicting results comparing living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) for HCC. Thus, disease-free survival (DFS) and overall survival (OS) were compared after LDLT and DDLT for HCC in a systematic review and meta-analysis. Twelve studies satisfied eligibility criteria for DFS, including 633 LDLT and 1232 DDLT. Twelve studies satisfied eligibility criteria for OS, including 637 LDLT and 1050 DDLT. Altogether, there were 16 unique studies; 1, 2, and 13 of these were rated as high, medium, and low quality, respectively. Studies were heterogeneous, non-randomized, and mostly retrospective. The combined hazard ratio was 1.59 (95% confidence interval [CI]: 1.02-2.49; I 2 = 50.07%) for DFS after LDLT vs. DDLT for HCC, and 0.97 (95% CI: 0.73-1.27; I 2 = 5.68%) for OS. This analysis provides evidence of lower DFS after LDLT compared with DDLT for HCC. Improved study design and reporting is required in future research to ascribe the observed difference in DFS to study bias or biological risk specifically associated with LDLT.

Optimization of immunosuppressive medication upon liver transplantation against HCC recurrence

“…There is no convincing evidence that graft type has a significant influence on recurrence rates. Two recent meta-analysis comparing HCC recurrence rates between living donor liver transplant and deceased donor liver transplant came to opposite conclusions (12,13). Additionally, there is no evidence that a donor after cardiac death (DCD) compared to donor after brainstem death (DBD) liver has any influence on HCC recurrence rates post-transplant (14,15).…”

Liver transplantation for hepatocellular carcinoma from living-donor vs. deceased donor

“…No prospective study has ever challenged the matter, however, there were two systematic reviews with meta-analyses so far. Grant et al (24) performed a meta-analysis on 12 retrospective studies comparing the recurrence rates and recurrence-free survival between LDLT and DDLT recipients. A total of 633 LDLTs and 1,232 DDLTs were enrolled, and the study provided evidence of lower disease-free survival after LDLT compared with DDLT for HCC [hazard ratio =1.59; confidence interval (CI): 1.02−2.49; P=0.041].…”

Surgical management of hepatocellular carcinoma

“…These found overall survival rates to be similar between the two groups. One of these, by Grant et al [66] found LDLTs to be associated with decreased disease-free survival rates. On the other hand, Liang et al [67] performed a subgroup analysis of patients within the Milan criteria and found similar survival outcomes between the two groups.…”