Living Donor Liver Transplantation (LDLT) for Hepatocellular Carcinoma (HCC) within and Outside Traditional Selection Criteria

Abstract

Objective: We evaluated long-term oncologic outcomes of patients post-LDLT within and outside standard transplant selection criteria and the added value of the incorporation of the New York-California (NYCA) score. Summary Background Data: LDLT offers an opportunity to decrease the liver transplant waitlist, reduce waitlist mortality and expand selection criteria for patients with HCC. Methods: Primary adult LDLT recipients between Oct-1999 and Aug-2019 were identified from a multicenter cohort of twelve North American centers. Post-transplant and recurrence-free survival were evaluated using the Kaplan-Meier method. Results: Three-hundred-and-sixty LDLTs were identified. Patients within Milan criteria (MC) at transplant had a 1-,5-, and 10-year post-transplant survival of 90.9%,78.5%, and 64.1% vs. outside MC 90.4%,68.6%, and 57.7%(P=0.20). For patients within the UCSF criteria, respective post-transplant survival was 90.6%,77.8%, and 65.0%, vs. outside UCSF 92.1%,63.8%, and 45.8%(P=0.08). Fifty-three (83%) patients classified as outside MC at transplant would have been classified as either low- or acceptable risk with the NYCA score. These patients had a 5-year OS of 72.2%. Similarly, 28(80%) patients classified as outside UCSF at transplant would have been classified as low- or acceptable risk with a 5-year OS of 65.3%. Conclusions: Long-term survival is excellent for patients with HCC undergoing LDLT within and outside selection criteria, exceeding the minimum recommended 5-years rate of 60% proposed by consensus guidelines. The NYCA categorization offers insight into identifying a substantial proportion of patients with HCC outside the MC and the UCSF criteria who still achieve similar post-LDLT outcomes as patients within the criteria.

Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy

“…There have been further adjustments to the classification for HCC, which have not been discussed further here [ 28 , 43 , 49 , 50 ]. These include, for example, the modification of the TNM criteria for HCC from Pittsburgh [ 51 ] and the Hangzhou criteria [ 49 ] for LT at HCC.…”

Effective Living Donor Evaluation in a Western Liver Transplantation Program

“…We have shown for which patients living donation is a good alternative to deceased organ donation. Living donation can be considered especially in the combination of decompensated underlying disease and a low MELD score or for patients with malignant disease without the option for exceptional MELD [30][31][32][33][34][35].…”

Evaluation of Overall Survival and Disease-Free Survival in Patients Receiving Liver Transplantation for Hepatocellular Carcinoma and Comparison of Living Versus Deceased Donor Liver Transplants: Results of 15 Years of Experience

“…A study comparing recipients who met Milan and UCSF criteria found no difference in survival rates following LT. 10 A multicenter study demonstrated that the 10-year survival rates after LDLT in patients within Milan and UCSF criteria were 64.1% and 69.4%, respectively. 11 In the Asian perspective, overall survival rates ranged from 80% to 85.2% after LT with more expanded selection criteria. 12 According to the present study, the overall survival rates at 1, 5, and 10 years were consistent with previous studies.…”