Ann Liver Transplant.  2024 Nov;4(2):71-79. 10.52604/alt.24.0008.

Chronological improvements of living donor liver transplantation for hepatocellular carcinoma in Seoul National University Hospital

• Gongor SO
• Lee KW
• Yi NJ
• Choi Y
• Hong SK
• Lee JM
• Kim JY
• Suh KS

• KMID: 2561851
• DOI: http://doi.org/10.52604/alt.24.0008

Abstract

Background
Challenging clinical circumstances and high demand for liver transplantation have led to a refinement in the recipient selection criteria. This study aims to investigate the hypothesis that surgical outcomes in living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) have improved over time with the shift from morphological to biological criteria.
Methods
A retrospective analysis was conducted on 942 adult HCC patients underwent LDLT at Seoul National University Hospital between 2000 and 2022. Study populations were divided into Group A (2000.01.01–2011.06.30, n=314) and Group B (2011.07.01–2022.06.30, n=628). Baseline characteristics, perioperative factors, and survival outcomes were compared.
Results
Group B demonstrated higher recurrence-free survival (RFS) compared to Group A (p=0.03). Additionally, Group B exhibited superior overall survival rates at the 1-, 3-, and 5-year intervals (95.9%, 87.9%, 84.6%, p<0.01). Moreover, Group B had a significantly lower recurrence rate (p=0.02) and mortality rate (p<0.01). The median time to recurrence was 9.1 months (interquartile range [IQR] 3.9–21.8) for Group A and 11.4 months (IQR 6.6–18.5) for Group B (p=0.92). Furthermore, Group A’s median tumor-bearing survival was 12.3 months (IQR 5.2–26.1), which was significantly shorter than Group B’s 20.0 months (IQR 5.4–25.7) (p<0.01).
Conclusion
The use of biological tumor markers in patient selection criteria has significantly improved the effectiveness of HCC treatment in LDLT and should be encouraged for pervasive use.

Keyword

Hepatocellular carcinoma; Liver transplantation; Mortality; Recurrence; Survival after recurrence