HomeOncologyOncology NewsExperts advise using live donors for HCC patients’ liver transplants

Experts advise using live donors for HCC patients’ liver transplants

A liver transplant is the best treatment for some patients with hepatocellular cancer (HCC).

However, there’s a long waiting list for all organ transplants.

A new study reveals that outcomes with liver transplants from live donors are higher than outcomes with transplants from deceased donors, resulting in calls rising the supply of live donation.

“Transplant programs worldwide ought to be inspired to increase their live donor programs to handle patients with HCC,” suggest authors of the new study, published in September in JAMA Surgery.

The findings are essential in light of the truth that amongst patients with HCC, liver transplants are restricted to these patients who have the highest possibilities of survival, owing to lengthy donor organ ready lists, say the authors. The use of transplants from residing donors might improve the supply of organs for patients on the deceased donor waiting list.


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“One might even argue that a residing donor provides two organs back to the organ pool,” the authors remark.

“Efforts to increase the donor pool via residing donor liver transplant for patients with HCC will ultimately increase the number of available deceased donor liver transplants to help all patients in need of a liver transplant,” David A Gerber, MD, of the University of North Carolina at Chapel Hill, and colleagues write in an accompanying commentary.

“It is vitally essential that donors aren’t recruited or solicited, but with the expansion of transplant packages, extra potential donors will turn out to be conscious of this opportunity and will step forward looking for to assist another person,” Gerber commented to Medscape Medical News.

Reduce the risk of dying by donating a live Liver

The new research was carried out by first writer Quirino Laid, MD, Ph.D., of the Department of General Surgery and Organ Transplantation, Sapienza University, Rome, Italy, and colleagues. They indicated that the necessity to better understand the potential advantages of residing donor organs is urgent. Liver cancer rates continue to rise, and the demand for organs outpaces the availability. Though various smaller studies have proven survival advantages of live donor liver transplants for individuals with HCC, the debate continues. Earlier evidence has recommended greater cancer recurrence rates and unfavorable outcomes.

The multicenter study is considered to be the largest to date on this issue. The investigators evaluated data from patients who were on liver donation ready lists for a primary transplant between January 2000 and December 2017. The study included two cohorts of patients on waiting lists: an international cohort, consisting of 3052 patients at 12 collaborative transplant centers in Europe, Asia, and the US; and a Canadian cohort, consisting of 906 patients.

Nearly all of the patients have been males (80.2%). The median age at the time of the first referral was 58 years.

One third of patients (33.1%) in the international cohort and barely fewer than a 3rd (27%) in the Canadian cohort obtained reside donor liver transplants; the remainder obtained liver transplants from deceased donors.

The median follow-up period was 3.3 years. Receiving a live donor liver transplant was independently related to a 49% reduction in the overall risk for death (hazard ratio [HR], 0.51) in the international cohort and a 43% discount in the Canadian cohort (HR, 0.57; each P < .001).

After adjustment for potential confounders, living donor liver transplantation remained independently related to a reduced risk for overall death. There was a reduction of 33% in the international cohort (P = .001) and a reduction of 48% in the Canadian cohort (P < .001).

“Divergent experiences all converged to a similar 40% to 50% reduction in intention-to-treat death risk,” the authors write.

Importantly, there was no increase in post-transplant cancer recurrence rates in the live donor groups in both cohorts. Rates ranged from 13% to 16% over 5 years and from 17% to 22% after 10 years in each group.

The median amount of time on the waiting list was considerably shorter for patients in the live donor group than for those in the deceased donor group (1 month vs 6 months in the international cohort [P < .001]; 5 months vs 6 months in the Canadian cohort [P = .006]).

Notably, in the deceased donor teams, there were 295 dropouts, compared with no dropouts among the many live donor patients in the international cohort (P < .001). In the Canadian cohort, the corresponding rates were 32.2% and 13.9% (P < .001).

Study Stands Out to Larger Cohorts and Diverse Transplant Centers

Even these latest results are consistent with those of the latest studies carried out in France, Hong Kong, and elsewhere, in the current study, the cohorts were bigger, say the authors.

“In contrast with earlier studies, all of which were based mostly on comparatively small case series, the current research examined the info of virtually 4,000 patients who were on a waiting list for a transplant; subsequently, this study could be the largest cohort study on this topic,” they point out.

Along with improved timing of a transplant, other factors, like patient selection, help explain the better survival, editorialist Gerber commented to Medscape Medical News.

“Survival improvement with live donor liver transplants is a combination of surgeon experienced in this transplant process and an appropriate selection bias, which indicates taking patients who aren’t too sick whereas waiting on the transplant but who would profit from the operation,” he said.

Gaining that have may be particularly challenging in the US, owing to regulatory obstacles to expanding the programs, however efforts to overcome that are moving ahead, Gerber added.

“This case of the where a person gains the expertise or experience is being discussed as transplantation has grown worldwide,” he notes.

As programs expand, the availability of live liver donors ought to enhance, he suggested.

In an associated story, Medscape recently reported on the controversial situation of a liver transplant as a choice for the treatment of liver metastases resulting from colorectal cancer.

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