Living donor liver transplantation versus deceased donor liver transplantation for hepatocellular carcinoma: A meta‐analysis

Because of the severe organ shortage, living donor liver transplantation (LDLT) offers a timely alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, the higher recurrence rate of HCC after LDLT and the indication criteria remain contro...

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Published in:Liver transplantation 2012-10, Vol.18 (10), p.1226-1236
Main Authors: Liang, Wenhua, Wu, Linwei, Ling, Xiaoting, Schroder, Paul M., Ju, Weiqiang, Wang, Dongping, Shang, Yushu, Kong, Yuan, Guo, Zhiyong, He, Xiaoshun
Format: Article
Language:English
Subjects:
Carcinoma, Hepatocellular - epidemiology
Carcinoma, Hepatocellular - mortality
Carcinoma, Hepatocellular - surgery
Female
Humans
Liver Neoplasms - epidemiology
Liver Neoplasms - mortality
Liver Neoplasms - surgery
Liver Transplantation - methods
Living Donors
Male
Neoplasm Recurrence, Local - epidemiology
Neoplasm Recurrence, Local - mortality
Prevalence
Survival Rate
Time Factors
Tissue Donors
Treatment Outcome
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Summary:Because of the severe organ shortage, living donor liver transplantation (LDLT) offers a timely alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, the higher recurrence rate of HCC after LDLT and the indication criteria remain controversial. By conducting a quantitative meta‐analysis, we sought to compare the survival outcomes and recurrence rates with LDLT and DDLT for patients with HCC. Comparative studies of LDLT and DDLT for HCC, which were identified by a comprehensive literature search, were included in this study. The evaluated outcomes included patient survival, recurrence‐free survival (RFS), and recurrence rates at defined time points. Seven studies with a total of 1310 participants were included in this study. For LDLT and DDLT recipients, we found comparable patient survival rates [1 year, odds ratio (OR) = 1.03, 95% confidence interval (CI) = 0.62‐1.73; 3 years, OR = 1.07, 95% CI = 0.77‐1.48; and 5 years, OR = 0.64, 95% CI = 0.33‐1.24] and RFS rates (1 year, OR = 0.86, 95% CI = 0.54‐1.38; 3 years, OR = 1.04, 95% CI = 0.69‐1.58; and 5 years, OR = 1.11, 95% CI = 0.70‐1.77). Moreover, we found no significant differences in the 1‐, 3‐, or 5‐year recurrence rates between LDLT and DDLT recipients (1 year, OR = 1.55, 95% CI = 0.36‐6.58; 3 years, OR = 2.57, 95% CI = 0.53‐12.41; and 5 years, OR = 1.21, 95% CI = 0.44‐3.32). A subgroup analysis revealed similar outcomes for patients with HCC meeting the Milan criteria. These findings demonstrate that for HCC patients (especially those within the Milan criteria), LDLT represents an acceptable option that does not compromise patient survival or increase HCC recurrence in comparison with DDLT. Liver Transpl 18:1226–1236, 2012. © 2012 AASLD.
ISSN:1527-6465
1527-6473
DOI:10.1002/lt.23490