• Tommy Ivanics, Marco P A W Claasen, Benjamin Samstein, Jean C Emond, Alyson N Fox, Elizabeth Pomfret, James Pomposelli, Parissa Tabrizian, Sander S Florman, Neil Mehta, John P Roberts, Juliet A Emamaullee, Yuri Genyk, Roberto Hernandez-Alejandro, Koji Tomiyama, Kazunari Sasaki, Koji Hashimoto, Shunji Nagai, Marwan Abouljoud, Kim M Olthoff, Maarouf A Hoteit, Julie Heimbach, Timucin Taner, AnnMarie H Liapakis, David C Mulligan, Gonzalo Sapisochin, Karim J Halazun, and North American Living Liver Donor Innovation Group (NALLDIG).
• Multi-Organ Transplant Program, Department of Surgery, University Health Network, Toronto, Canada.
• Ann. Surg. 2024 Jan 1; 279 (1): 104111104-111.

ObjectiveTo evaluate long-term oncologic outcomes of patients post-living donor liver transplantation (LDLT) within and outside standard transplantation selection criteria and the added value of the incorporation of the New York-California (NYCA) score.BackgroundLDLT offers an opportunity to decrease the liver transplantation waitlist, reduce waitlist mortality, and expand selection criteria for patients with hepatocellular carcinoma (HCC).MethodsPrimary adult LDLT recipients between October 1999 and August 2019 were identified from a multicenter cohort of 12 North American centers. Posttransplantation and recurrence-free survival were evaluated using the Kaplan-Meier method.ResultsThree hundred sixty LDLTs were identified. Patients within Milan criteria (MC) at transplantation had a 1, 5, and 10-year posttransplantation survival of 90.9%, 78.5%, and 64.1% versus outside MC 90.4%, 68.6%, and 57.7% ( P = 0.20), respectively. For patients within the University of California San Francisco (UCSF) criteria, respective posttransplantation survival was 90.6%, 77.8%, and 65.0%, versus outside UCSF 92.1%, 63.8%, and 45.8% ( P = 0.08). Fifty-three (83%) patients classified as outside MC at transplantation would have been classified as either low or acceptable risk with the NYCA score. These patients had a 5-year overall survival of 72.2%. Similarly, 28(80%) patients classified as outside UCSF at transplantation would have been classified as a low or acceptable risk with a 5-year overall survival of 65.3%.ConclusionsLong-term survival is excellent for patients with HCC undergoing LDLT within and outside selection criteria, exceeding the minimum recommended 5-year rate of 60% proposed by consensus guidelines. The NYCA categorization offers insight into identifying a substantial proportion of patients with HCC outside the MC and the UCSF criteria who still achieve similar post-LDLT outcomes as patients within the criteria.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

27 keywords...

hide…