Living vs. deceased-donor liver transplantation for patients with hepatocellular carcinoma

Abstract

With the scarcity of deceased donor liver grafts, living donor liver transplantation (LDLT) is gaining popularity as an alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, as the evidence of cases of LDLT accumulates, several authors have reported higher HCC recurrence rates after LDLT. The suggested reasons for the higher recurrence rates following LDLT are related to the small-for-size graft in LDLT, surgical procedures that are specific to LDLT, and the fast-track to LDLT. Fast-tracking to LDLT may not allow sufficient time for evaluation of the biological aggressiveness of tumors, which may result in high recurrence rates due to inclusion of patients with more inherently aggressive tumors. Actually, some studies that reported higher recurrence rates with LDLT included a larger number of cases of HCC with microvascular invasion or poorly differentiated HCC. In order to exclude biologically aggressive HCC preoperatively, selection criteria incorporating tumor markers, such as alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP), as well as morphological tumor number and size have been proposed. With more reliable selection criteria incorporating biological markers to eliminate biologically aggressive HCC, LDLT can be a viable treatment option for patients with HCC, providing similar recurrence rates as those achieved with DDLT.

Hepatocellular carcinoma recurrence in living and deceased donor liver transplantation

“…Only findings from retrospective studies have supplied some evidence that can be used to address this issue at present. Though systematic reviews and/or meta-analyses [10–12] exist, variables associated with these reports lack sufficient descriptions. While cohort studies of large samples can provide important information on the relationships between observed factors and events and control for major confounding factors, the complicated nature of liver transplantation limits their utility.…”

How far can we go with hepatocellular carcinoma in living donor liver transplantation?

“…Outcomes after LDLT versus DDLT have been extensively studied, with publications showing the absence of difference between treatments [5,9]. LDLT results are comparable with DDLT for both donation after circulatory death (DCD) and donation after brain death (DBD), as published by Kollmann et al [10] that demonstrated similar 5-year overall patient survival of 71.6% for DCD, 83% for DBD, 88.8% for LDLT, and graft survival of 69.2% for DCD, 79.9% for DBD, and 84.7% for LDLT among 1054 patients from a single center (P ¼ 0.14).…”

Usefulness of a Balloon Catheter for Intraoperative Cholangiography During Living Donor Hepatectomy: A Product Investigation

“…Living donor liver transplants are relatively common in Japan due to the scarcity of deceased donors [ 1 ]. Intraoperative cholangiography (IOC) during living donor liver procurement for liver transplantation is an essential procedure to avoid biliary complications in the donor and to assess the details of the biliary anatomy of the graft liver for the recipient [ 2 ].…”