Outcome of ABO-incompatible adult living-donor liver transplantation for patients with hepatocellular carcinoma

Abstract

Introduction: Living-donor liver transplantation can simultaneously cure hepatocellular carcinoma and underlying liver cirrhosis, improving long-term results in patients with hepatocellular carcinoma. ABO-incompatible living-donor liver transplantation could expand the living-donor pool, reduce waiting times for deceased-donor liver transplantation, and improve long-term survival for some patients with hepatocellular carcinoma. Method: We retrospectively reviewed the medical records of patients undergoing living-donor liver transplantation for hepatocellular carcinoma from November 2008 to December 2015 at a single institution in Korea. In total, 165 patients underwent ABO-incompatible and 753 patients underwent ABO-compatible living-donor liver transplantation for hepatocellular carcinoma. Result: We performed 1:1 propensity score matching and included 165 patients in each group, finding that ABO-incompatible recipients underwent desensitization to overcome the ABO blood-group barrier, including pre-transplant plasma exchange and rituximab administration (300–375 mg/m2 body surface area). ABO-incompatible and -compatible living-donor liver-transplantation groups were followed up for 48.03 and 48.68 months, respectively, with both groups showing comparable recurrence-free survival rates (hazard ratio: 1.14, 95% confidence interval: 0.68–1.90; P = 0.630) and overall patient-survival outcomes (hazard ratio 1.10, 95% confidence interval: 0.60–2.00; P = 0.763). Conclusion: These findings suggested that ABO-incompatible liver transplantation is a feasible option for hepatocellular carcinoma patients, especially those with compensated cirrhosis with HCC within conventional Milan criteria.