Korean J Transplant.  2023 Nov;37(Suppl 1):S224. 10.4285/ATW2023.F-8134.

Outcomes of living donor liver transplantation in patients with concurrent extrahepatic malignancy

• Park JH
• Kim J
• Ahn S
• Rhu J
• Choi GS
• Joh JW

• KMID: 2551844
• DOI: http://doi.org/10.4285/ATW2023.F-8134

Abstract

Background
Pre-existing extrahepatic malignancy (EHM) has long been considered a relative contraindication for liver transplantation due to the risk of cancer recurrence. Therefore, minimum cancer remission times before liver transplantation have been recommended. However, we were frequently challenged with concurrent EHM in patients for whom living donor liver transplantation (LDLT) may be the only life-saving option available, in the setting of end-stage liver disease or hepatocellular carcinoma. In this study, we analyze the outcomes of LDLT in adults with concurrent EHM at the time of transplantation.
Methods
Out of 2,448 adults who underwent LDLT from May 1996 to January 2023 at our institution, we retrospectively analyzed data for 16 patients with EHM treated within 6 months of (before, during or after) LDLT.
Results
Among 16 patients, a total of 5 patients died during follow-up; only 1 of these died due to a cancer-related cause. Overall, the 1-year survival rate was 87.5%; the 3-year survival rate, 81.3%; and 5-year survival rate, 75.0%. None of the eight patients with low-risk EHM showed EHM recurrence after LDLT. EHM recurrence occurred in one patient with intermediate risk, and cancer progression was seen in one patient with high-risk EHM. Concurrent hepatocellular carcinoma (HCC) was present in six patients, and HCC recurrence occurred in two patients (33.3%). Kaplan-Meier (log-rank) analysis between patients with hematologic (n=5) and non-hematologic (n=11) EHM showed no difference in survival (P=0.891).
Conclusions
Our study shows high survival rates for LDLT in patients with concurrent EHM. The rate of EHM recurrence or progression (12.5%) was lower than the rate of HCC recurrence (33.3%). Hence, we suggest concurrent EHM should not be a contraindication to LDLT even when minimum remission times have not elapsed yet. LDLT may serve as both a life-saving option in liver failure and a bridge for patients to fully receive therapy for their concurrent EHM.