Association between Hepatocellular Carcinoma Recurrence and Graft Size in Living Donor Liver Transplantation: A Systematic Review

Abstract

The aim of this work was to assess the association between graft-to-recipient weight ratio (GRWR) in adult-to-adult living donor liver transplantation (LDLT) and hepatocellular carcinoma (HCC) recurrence. A search of the MEDLINE and EMBASE databases was performed until December 2022 for studies comparing different GRWRs in the prognosis of HCC recipients in LDLT. Data were pooled to evaluate 1- and 3-year survival rates. We identified three studies, including a total of 782 patients (168 GRWR < 0.8 vs. 614 GRWR ≥ 0.8%). The pooled overall survival was 85% and 77% at one year and 90% and 83% at three years for GRWR < 0.8 and GRWR ≥ 0.8, respectively. The largest series found that, in patients within Milan criteria, the GRWR was not associated with lower oncological outcomes. However, patients with HCC outside the Milan criteria with a GRWR < 0.8% had lower survival and higher tumor recurrence rates. The GRWR < 0.8% appears to be associated with lower survival rates in HCC recipients, particularly for candidates with tumors outside established HCC criteria. Although the data are scarce, the results of this study suggest that considering the individual GRWR not only as risk factor for small-for-size-syndrome but also as contributor to HCC recurrence in patients undergoing LDLT would be beneficial. Novel perfusion technologies and pharmacological interventions may contribute to improving outcomes.

Risk assessment in liver transplantation for hepatocellular carcinoma: long-term follow-up of a two-centre experience

“…While the exact correlation between ischaemia time and risk profile in this context is not established, various methods of increased ischaemic time do seem to introduce potential for increased acute and ongoing inflammation and thus poorer outcomes. A leading proposed mechanism for this is the pro-inflammatory microenvironment associated with ischaemic reperfusion injury (IRI) that comes with longer ischaemic time, and it is proposed that pharmacological, logistical, or even surgical techniques to reduce IRI reduce the risk of recurrence 39 . This same inflammatory environment is present in post-transplant regeneration of split-donor or living-donor grafts, and thus it is not surprising that the higher rate of regeneration in small-for-size grafts has been shown to increase the risk of HCC recurrence 40 .…”

“…A leading proposed mechanism for this is the pro-inflammatory microenvironment associated with ischaemic reperfusion injury (IRI) that comes with longer ischaemic time, and it is proposed that pharmacological, logistical, or even surgical techniques to reduce IRI reduce the risk of recurrence 39 . This same inflammatory environment is present in post-transplant regeneration of split-donor or living-donor grafts, and thus it is not surprising that the higher rate of regeneration in small-for-size grafts has been shown to increase the risk of HCC recurrence 40 . This risk was most pronounced in LT outside Milan, a finding that could be extrapolated to the higher risk associated with DCD grafts outside Milan in our study.…”

Changes in Serum Bone Metabolism Markers after Living Donor Liver Transplantation (LDLT) and Their Association with Fracture Occurrences

“…Living donor liver transplantation (LDLT) is a life-saving operation with a good longterm survival rate, a biliary complications rate < 7% and a reoperation rate < 3% [1][2][3][4][5]. Due to the merits mentioned above, LDLT is the most common form of liver transplantation in Asia at present [6].…”