Small graft size and hepatocellular carcinoma outcomes in living donor liver transplantation: a retrospective multicentric cohort study.

Abstract

INTRODUCTION:

This study examined associations between the graft-to-recipient weight ratio (GRWR) for adult-to-adult living donor liver transplantation (LDLT) and HCC outcomes.

MATERIALS AND METHODS:

Data from patients in the Korean Organ Transplantation Registry who underwent LDLT for HCC from 2014-2021 were retrospectively reviewed. Patients were categorized using the cutoff GRWR for HCC recurrence determined by an adjusted cubic spline (GRWR<0.7% vs. GRWR≥0.7%). Recurrence-free survival (RFS) and HCC recurrence were analyzed in the entire and a 1:5 propensity-matched cohort.

RESULTS:

The eligible cohort consisted of 2005 LDLT recipients (GRWR<0.7 [n=59] vs. GRWR≥0.7 [n=1946]). In the entire cohort, 5-year RFS was significantly lower in the GRWR<0.7 than in the GRWR≥0.7 group (66.7% vs. 76.7%, P =0.019), although HCC recurrence was not different between groups (77.1% vs. 80.7%, P =0.234). This trend was similar in the matched cohort ( P =0.014 for RFS and P =0.096 for HCC recurrence). In multivariable analyses, GRWR<0.7 was an independent risk factor for RFS (adjusted HR [aHR] 1.89, P =0.012), but the result was marginal for HCC recurrence (aHR 1.61, P =0.066). In the pretransplant tumor burden subgroup analysis, GRWR<0.7 was a significant risk factor for both RFS and HCC recurrence only for tumors exceeding the Milan criteria (aHR 3.10, P <0.001 for RFS; aHR 2.92, P =0.003 for HCC recurrence) or with MoRAL scores in the fourth quartile (aHR 3.33, P <0.001 for RFS; aHR 2.61, P =0.019 for HCC recurrence).

CONCLUSIONS:

A GRWR<0.7 potentially leads to lower RFS and higher HCC recurrence after LDLT when the pretransplant tumor burden is high.

• Authors: Deok-Gie Kim, Shin Hwang, Kwang-Woong Lee, Jong Man Kim, Young Kyoung You, Donglak Choi, Je Ho Ryu, Bong-Wan Kim, Dong-Sik Kim, Jai Young Cho, Yang Won Nah, Man Ki Ju, Tae-Seok Kim, Jae Geun Lee, Myoung Soo Kim, Alessandro Parente, Ki-Hun Kim, Andrea Schlegel, Soo Jin Na Choi, Dong Jin Joo, Korean Organ Transplantation Registry Study Group
• Journal: International journal of surgery (London, England) (Int J Surg) (May 03 2024) ISSN: 1743-9159 [Electronic] United States
• PMID: 38701521 (Publication Type: Journal Article)
• Copyright: Copyright © 2024 The Author(s). Published by Wolters Kluwer Health, Inc.