Research Report
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World J Gastroenterol. Apr 21, 2014; 20(15): 4393-4400
Published online Apr 21, 2014. doi: 10.3748/wjg.v20.i15.4393
Living-donor or deceased-donor liver transplantation for hepatic carcinoma: A case-matched comparison
Ping Wan, Jian-Jun Zhang, Qi-Gen Li, Ning Xu, Ming Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia
Ping Wan, Jian-Jun Zhang, Qi-Gen Li, Ning Xu, Ming Zhang, Xiao-Song Chen, Long-Zhi Han, Qiang Xia, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
Author contributions: Xia Q is the guarantor and designed the study; Wan P conducted the majority of the study and wrote the manuscript; Xia Q, Zhang JJ, Li QG, Xu N, Zhang M, Chen XS and Han LZ offered suggestions for this work and revised the manuscript.
Supported by Key Discipline and Specialty Foundation of Shanghai Municipal Commission of Health and Family Planning; Training Program for Superb Academic Leaders in Shanghai Health System, No. XBR2011029; Special Fund for Building of Leading Talent Teams in Shanghai
Correspondence to: Qiang Xia, Professor, Department of Liver Surgery, Ren Ji Hospital, School of Medicine, Shanghai Jiao Tong University, No. 1630 Dongfang Road, Shanghai 200127, China. xiaqiang@medmail.com.cn
Telephone: +86-21-68383775 Fax: +86-21-58737232
Received: September 29, 2013
Revised: December 30, 2013
Accepted: February 17, 2014
Published online: April 21, 2014
Processing time: 200 Days and 5 Hours
Abstract

AIM: To compare the surgical outcomes between living-donor and deceased-donor liver transplantation in patients with hepatic carcinoma.

METHODS: From January 2007 to December 2010, 257 patients with pathologically confirmed hepatic carcinoma met the eligibility criteria of the study. Forty patients who underwent living-donor liver transplantation (LDLT) constituted the LDLT group, and deceased-donor liver transplantation (DDLT) was performed in 217 patients. Patients in the LDLT group were randomly matched (1:2) to patients who underwent DDLT using a multivariate case-matched method, so 40 patients in the LDLT group and 80 patients in the DDLT group were enrolled into the study. We compared the two groups in terms of clinicopathological characteristics, postoperative complications, long-term cumulative survival and relapse-free survival outcomes. The modified Clavien-Dindo classification system of surgical complications was used to evaluate the severity of perioperative complications. Furthermore, we determined the difference in the overall biliary complication rates in the perioperative and follow-up periods between the LDLT and DDLT groups.

RESULTS: The clinicopathological characteristics of the enrolled patients were comparable between the two groups. The duration of operation was significantly longer (553 min vs 445 min, P < 0.001) in the LDLT group than in the DDLT group. Estimated blood loss (1188 mL vs 1035 mL, P = 0.055) and the proportion of patients with intraoperative transfusion (60.0% vs 43.8%, P = 0.093) were slightly but not significantly greater in the LDLT group. In contrast to DDLT, LDLT was associated with a lower rate of perioperative grade II complications (45.0% vs 65.0%, P = 0.036) but a higher risk of overall biliary complications (27.5% vs 7.5%, P = 0.003). Nonetheless, 21 patients (52.5%) in the LDLT group and 46 patients (57.5%) in the DDLT group experienced perioperative complications, and overall perioperative complication rates were similar between the two groups (P = 0.603). No significant difference was observed in 5-year overall survival (74.1% vs 66.6%, P = 0.372) or relapse-free survival (72.9% vs 70.9%, P = 0.749) between the LDLT and DDLT groups.

CONCLUSION: Although biliary complications were more common in the LDLT group, this group did not show any inferiority in long-term overall survival or relapse-free survival compared with DDLT.

Keywords: Liver cancer; Hepatocellular carcinoma; Liver transplantation; Living donor; Survival; Recurrence; Complication

Core tip: Several retrospective studies from single centers have shown that living-donor liver transplantation (LDLT) might be associated with higher rates of tumor recurrence than deceased-donor liver transplantation (DDLT). In this study, we compared the surgical outcomes between LDLT and DDLT in patients with hepatic carcinoma using a multivariate case-matched method, which minimized the disparity from case selection and thus made our results statistically more persuasive than others. Our results suggest that LDLT did not show any inferiority in long-term overall survival or relapse-free survival in comparison with DDLT.