Outcomes of Patients with Hepatocellular Carcinoma Undergoing Liver Transplantation Utilizing Extended Criteria Donor Grafts.

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  • Additional Information
    • Source:
      Publisher: Elsevier Science Inc Country of Publication: United States NLM ID: 0243532 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1873-2623 (Electronic) Linking ISSN: 00411345 NLM ISO Abbreviation: Transplant Proc Subsets: MEDLINE
    • Publication Information:
      Publication: New York, N.Y. : Elsevier Science Inc.
      Original Publication: New York Stratton.
    • Subject Terms:
      Liver Transplantation*/mortality ; Carcinoma, Hepatocellular*/surgery ; Carcinoma, Hepatocellular*/mortality ; Liver Neoplasms*/surgery ; Liver Neoplasms*/mortality ; Graft Survival* ; Tissue Donors*/supply & distribution; Humans ; Male ; Female ; Middle Aged ; Donor Selection ; Tissue and Organ Procurement/methods ; Treatment Outcome ; Adult ; United States ; Retrospective Studies ; Aged
    • Abstract:
      Background: The deceased donor shortage in the United States has led to increased utilization extended criteria donor (ECD) liver grafts. Centers often utilize ECD grafts in patients with low Model for End-Stage Liver Disease (MELD) scores, like patients with hepatocellular carcinoma (HCC). However, few studies have directly examined the outcomes of using ECD grafts in patients with HCC.
      Methods: Adults receiving liver transplantation (LT) for HCC between 2010 and 2020 were identified in the Organ Procurement and Transplantation Network database. Recipients were categorized according to donor type: standard criteria donor (SCD), extended criteria donor, donation after brain death (ECD-DBD), and donation after circulatory death (DCD). Multivariable Cox regression analysis identified variables associated with overall or graft survival at 3 years post-LT.
      Results: Most patients received ECD-DBD grafts (51.4%); only 8.3% received DCD grafts. The time on the waitlist was similar for ECD and SCD recipients (P = .79). SCD recipients had higher 5-year overall survival post-LT than ECD-DBD or DCD recipients (79.1%, 77.1%, and 76.8%, respectively, P < .001). Similarly, 5-year graft survival was also highest in SCD recipients (SCD = 77.8%, ECD-DBD = 75.7%, and DCD = 72.2%, P < .001). In multivariable analysis, DCD grafts increased mortality risk (hazard ratio [HR] = 1.33, 95% confidence interval [CI] = 1.12-1.57, P = .001), but ECD-DBD grafts did not (HR = 1.10, 95% CI = 1.00-1.22, P = .052).
      Conclusions: DCD and ECD-DBD recipients had significantly lower overall and graft survival. However, the survival benefit of LT for patients with HCC greatly outweighs the small differences in patient and graft survival from using ECD grafts. Further research should investigate whether treatment of ECD grafts with machine perfusion may ameliorate this discrepancy.
      Competing Interests: Declaration of competing interest The authors have no conflicts of interest to declare for this manuscript.
      (Copyright © 2024 Elsevier Inc. All rights reserved.)
    • Publication Date:
      Date Created: 20241201 Date Completed: 20241215 Latest Revision: 20241215
    • Publication Date:
      20241216
    • Accession Number:
      10.1016/j.transproceed.2024.10.039
    • Accession Number:
      39617682