Long-term outcomes of the patients with hepatocellular carcinoma after living donor liver transplantation using left lobe graft.

Abstract

e14649 Background: Adult living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) has become a routine treatment option for patients waiting for liver transplantation. LDLT using right lobe (RL) grafts has gained widespread acceptance, whereas the use of let lobe (LL) grafts for adults has been severely limited because of their size limitation. The aim of this study was to analyze the long-term outcomes of LDLT for HCC according to the graft type. Methods: A retrospective analysis was performed of the recipients’ outcomes of LL graft (n=82) versus recipients of RL graft (n=46) between July 1995 and November 2009. The analysis endpoints were overall and recurrence-free survival after LDLT. Recipient demographics and tumor characteristics by the graft type were also analyzed. Results: No difference was found in the gender, hepatitis virus type, alpha-fetoprotein level, number of tumors, maximum tumor size, Milan classification, microscopic tumor differentiation and the presence of microvascular invasion between the two groups. The graft volume (436 ± 74 g) as well as the graft volume-standard liver volume rate (38.3 ± 6.2%) of the LL graft group was significantly less than those of RL graft group (569 ± 82 g, 46.3 ± 6.7%) (p<0.01). The 1-, 3-, 5- and 7-year overall survival rates of LL graft group were 88.2%, 80.2%, 75.7% and 72.4%, respectively, which were not significantly different compared to those of RL graft group (95.4%, 87.3%, 87.3% and 87.3%). The recurrence-free survival rates of the LL graft group (89.1% at 1-year, 78.8% at 3-year, 75.8% at 5-year and 70.3% at 7-year) were similar to that of the RL graft group (88.6%, 88.6%, 88.6% and 88.6%). As for the donors, the rate of complications over Clavien’s IIIa in LL graft procurement was 6.2%, which was significantly lower than that in RL graft group (15.6%, P<0.05).The mean peak postoperative total bilirubin levels and duration of hospital stay after surgery of LL grafting donor were significantly less than those of RL grafting donor (P<0.01). Conclusions: Since the long-term outcomes in the HCC patients with LL graft were similar to that with RL graft, LL graft should be considered more favorably when selecting donors in LDLT for HCC.