TY - JOUR
T1 - Living Donor Liver Transplantation for Hepatocellular Carcinoma Within and Outside Traditional Selection Criteria
T2 - A Multicentric North American Experience
AU - Ivanics, Tommy
AU - Claasen, Marco P.A.W.
AU - the North American Living Liver Donor Innovation Group (NALLDIG)
AU - Samstein, Benjamin
AU - Emond, Jean C.
AU - Fox, Alyson N.
AU - Pomfret, Elizabeth
AU - Pomposelli, James
AU - Tabrizian, Parissa
AU - Florman, Sander S.
AU - Mehta, Neil
AU - Roberts, John P.
AU - Emamaullee, Juliet A.
AU - Genyk, Yuri
AU - Hernandez-Alejandro, Roberto
AU - Tomiyama, Koji
AU - Sasaki, Kazunari
AU - Hashimoto, Koji
AU - Nagai, Shunji
AU - Abouljoud, Marwan
AU - Olthoff, Kim M.
AU - Hoteit, Maarouf A.
AU - Heimbach, Julie
AU - Taner, Timucin
AU - Liapakis, Annmarie H.
AU - Mulligan, David C.
AU - Sapisochin, Gonzalo
AU - Halazun, Karim J.
N1 - Publisher Copyright:
© 2024 Lippincott Williams and Wilkins. All rights reserved.
PY - 2024/1
Y1 - 2024/1
N2 - Objective: To evaluate long-term oncologic outcomes of patients post-living donor liver transplantation (LDLT) within and outside standard transplantation selection criteria and the added value of the incorporation of the New York-California (NYCA) score. Background: LDLT offers an opportunity to decrease the liver transplantation waitlist, reduce waitlist mortality, and expand selection criteria for patients with hepatocellular carcinoma (HCC). Methods: Primary adult LDLT recipients between October 1999 and August 2019 were identified from a multicenter cohort of 12 North American centers. Posttransplantation and recurrence-free survival were evaluated using the Kaplan-Meier method. Results: Three hundred sixty LDLTs were identified. Patients within Milan criteria (MC) at transplantation had a 1, 5, and 10-year posttransplantation survival of 90.9%, 78.5%, and 64.1% versus outside MC 90.4%, 68.6%, and 57.7% (P = 0.20), respectively. For patients within the University of California San Francisco (UCSF) criteria, respective posttransplantation survival was 90.6%, 77.8%, and 65.0%, versus outside UCSF 92.1%, 63.8%, and 45.8% (P = 0.08). Fifty-three (83%) patients classified as outside MC at transplantation would have been classified as either low or acceptable risk with the NYCA score. These patients had a 5-year overall survival of 72.2%. Similarly, 28(80%) patients classified as outside UCSF at transplantation would have been classified as a low or acceptable risk with a 5-year overall survival of 65.3%. Conclusions: Long-term survival is excellent for patients with HCC undergoing LDLT within and outside selection criteria, exceeding the minimum recommended 5-year rate of 60% proposed by consensus guidelines. The NYCA categorization offers insight into identifying a substantial proportion of patients with HCC outside the MC and the UCSF criteria who still achieve similar post-LDLT outcomes as patients within the criteria.
AB - Objective: To evaluate long-term oncologic outcomes of patients post-living donor liver transplantation (LDLT) within and outside standard transplantation selection criteria and the added value of the incorporation of the New York-California (NYCA) score. Background: LDLT offers an opportunity to decrease the liver transplantation waitlist, reduce waitlist mortality, and expand selection criteria for patients with hepatocellular carcinoma (HCC). Methods: Primary adult LDLT recipients between October 1999 and August 2019 were identified from a multicenter cohort of 12 North American centers. Posttransplantation and recurrence-free survival were evaluated using the Kaplan-Meier method. Results: Three hundred sixty LDLTs were identified. Patients within Milan criteria (MC) at transplantation had a 1, 5, and 10-year posttransplantation survival of 90.9%, 78.5%, and 64.1% versus outside MC 90.4%, 68.6%, and 57.7% (P = 0.20), respectively. For patients within the University of California San Francisco (UCSF) criteria, respective posttransplantation survival was 90.6%, 77.8%, and 65.0%, versus outside UCSF 92.1%, 63.8%, and 45.8% (P = 0.08). Fifty-three (83%) patients classified as outside MC at transplantation would have been classified as either low or acceptable risk with the NYCA score. These patients had a 5-year overall survival of 72.2%. Similarly, 28(80%) patients classified as outside UCSF at transplantation would have been classified as a low or acceptable risk with a 5-year overall survival of 65.3%. Conclusions: Long-term survival is excellent for patients with HCC undergoing LDLT within and outside selection criteria, exceeding the minimum recommended 5-year rate of 60% proposed by consensus guidelines. The NYCA categorization offers insight into identifying a substantial proportion of patients with HCC outside the MC and the UCSF criteria who still achieve similar post-LDLT outcomes as patients within the criteria.
UR - https://www.scopus.com/pages/publications/85180312611
U2 - 10.1097/SLA.0000000000006049
DO - 10.1097/SLA.0000000000006049
M3 - Article
C2 - 37522174
AN - SCOPUS:85180312611
SN - 0003-4932
VL - 279
SP - 104
EP - 111
JO - Annals of Surgery
JF - Annals of Surgery
IS - 1
ER -