Source

Organ Transplant Center, the First Affiliated Hospital, Sun Yat-sen University, Guangzhou 510080, China.

Abstract

Living donor liver transplantation (LDLT) offers a timely alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC) in the circumstances of severe organ shortage. 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 between LDLT and DDLT in patients with HCC. Comparative studies of LDLT versus DDLT for HCC identified by a comprehensive literature search were included in this study. The outcomes evaluated were patient survival, recurrence-free survival and recurrence rates at defined time points. Seven studies with a total of 1310 participants were included in this study. We found comparable patient survival (1-year: OR = 1.03, 95% CI = 0.62-1.73; 3-year: OR = 1.07, 95% CI = 0.77-1.48; 5-year: OR = 0.64, 95% CI = 0.33-1.24) and recurrence-free survival (1-year: OR = 0.86, 95% CI = 0.54-1.38; 3-year: OR = 1.04, 95% CI = 0.69-1.58; 5-year: OR = 1.11, 95% CI = 0.70-1.77) between LDLT and DDLT recipients. 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-year: OR = 2.57, 95% CI 0.53-12.41; and 5-year: OR = 1.21, 95% CI 0.44-3.32). Subgroup analysis revealed similar outcomes for patients with HCC meeting Milan criteria. These findings demonstrate that LDLT represents an acceptable option that does not compromise patient survival or increase HCC recurrence when compared to DDLT for HCC patients, especially those within Milan criteria.