Reuters Health Information (2012-10-26): No higher risk of HCC recurrence after living donor transplant
No higher risk of HCC recurrence after living donor transplant
Last Updated: 2012-10-26 9:00:24 -0400 (Reuters Health)
NEW YORK (Reuters Health) - For patients with hepatocellular carcinoma (HCC), survival after liver transplant - and recurrence rates -- are similar with living or deceased donors, a meta-analysis from China shows.
The study "supports the concept that the use of (living donors) in patients with HCC would not increase posttransplant cancer recurrence," Dr. Zhiyong Guo told Reuters Health by email.
In an October 14th online paper in Liver Transplantation, Dr. Guo of Sun Yat-Sen University, Guangzhou and colleagues note that living donor liver transplantation (LDLT) "has become an important therapeutic modality for the treatment of HCC, particularly in areas of the world in which access to deceased donor organs is limited."
But, they add, "Some clinical studies support the concept that survival outcomes may be equal between LDLT and deceased donor liver transplant (DDLT), but the risk of recurrence may be higher with LDLT."
To gain further insight on recurrence risks, the researchers identified seven cohort studies that compared living- and deceased-donor liver transplants in a total of 1,310 HCC patients. Six of the studies were retrospective.
Most of the studies "demonstrated sufficient quality with reasonable selection criteria, comparable patient characteristics, and adequate follow-up of the subjects," the authors say. There was no evidence of publication bias.
At one year, survival in the LDLT and DDLT recipients was comparable in the five studies that gave such information. This was also the case at three years, based on data from all seven reports.
In the four studies with five-year data, there was still no significant difference. However unlike the other study groupings, statistically significant heterogeneity was found among these studies.
Furthermore, the pooled one-, three-, and five-year recurrence-free survival (RFS) rates with LDLT and DDLT were comparable, with no significant differences.
"We also demonstrated that LDLT shared equivalent outcomes with DDLT for HCC patients who met the Milan criteria and for HCC patients who exceeded the Milan criteria, and this indicates that LDLT would not yield worse oncological outcomes even in advanced cases in which tumors might recur more easily," the researchers say.
But, they write, it is unethical "to subject living donors to the danger of death merely for the short-term survival of such patients with advanced HCC."
"The current evidence," they go on to say, "does not support the expansion of LDLT to HCC patients beyond the Milan criteria, and further, detailed studies are required to clarify how well LDLT performs in this group of patients in comparison with DDLT."
In particular, the investigators conclude, for those who meet the Milan criteria, "LDLT represents an acceptable option that does not compromise patient survival or increase HCC recurrence in comparison with DDLT."
Liver Transpl 2012.