Korean J Transplant.  2022 Nov;36(Supple 1):S15. 10.4285/ATW2022.F-0912.

Posttransplant plasma exchange prevents hepatocellular carcinoma recurrence in ABO-incompatible liver transplantation: propensity-matched analysis

• Oh N
• Rhu J
• Kim JM
• Choi GS
• Joh JW

• KMID: 2535131
• DOI: http://doi.org/10.4285/ATW2022.F-0912

Abstract

Background
Total plasma exchange (TPE) may play a role in cancer treatment by eliminating immune checkpoint inhibitors. This study investigated whether TPE improved oncological outcomes in hepatocellular carcinoma (HCC) patients who under-went ABO-incompatible living donor liver transplantation.
Methods
The study included 158 patients who underwent ABO-incompatible living donor liver transplantation for HCC be-tween 2010 and 2021 at Samsung Medical Center. Recurrence-free survivals were analyzed using the Kaplan-Meier method after propensity score matching. In addition, the Cox regression model was used to identify factors associated with tumor recurrence.
Results
A propensity score matching resulted in 52 matched pairs, whether postoperative TPE [post-op TPE (+)] or not [postop TPE (–)]. The 5-year recurrence-free survival was superior in the post-op TPE (+) group (88.3% [95% confidence interval {CI}, 83.3%–93.3%]) compared to post-op TPE(–) group (61.1% [95% CI, 53.6%–68.6%]; P=0.003). Subgroup analysis performed for beyond Milan group showed superior 5-year recurrence-free survival in Post op TPE (+) group (86.2% [95% CI, 78.8%–93.6%]) compared to post-op TPE (–) group (36.9% [95% CI, 25.0%–48.8%]; P=0.001). In patients with microvascular invasion, post-op TPE (+) group also showed superior 5-year recurrence-free survival (82.9% [95% CI, 75.0%–90.8%]) compared to post-op TPE (–) group (31.0% [95% CI, 20.7%–41.3%]; P=0.001). In multivariable analysis, postoperative TPE significantly decreased the risk of tumor recurrence (hazard ratio, 0.24; 95% CI, 0.09–0.68; P=0.007).
Conclusions
Postoperative TPE improved recurrence-free survival after ABO-incompatible living donor liver transplantation for hepatocellular carcinoma, especially in advanced cases such as microvascular invasion and beyond Milan criteria.