Potential Role of the Donor in Hepatocellular Carcinoma Recurrence After Liver Transplantation

A subset of liver transplantation (LT) recipients who undergo transplantation for hepatocellular carcinoma (HCC) will develop postoperative recurrence. There has yet to be a thorough investigation of donor factors influencing recurrence. Data regarding adult, primary LT recipients with HCC (n=5002) who underwent transplantation between January 1, 2006 and September 30, 2010 were extracted from the United Network for Organ Sharing database, and the cumulative incidence of post-LT recurrence by donor factors was subsequently estimated. Among the HCC LT recipients, 324 (6.5%) developed recurrence. An analysis of donor characteristics demonstrated a higher cumulative incidence of recurrence within 4 years of transplantation among recipients with donors60 years old (11.8% versus 7.3% with donors<60 years old, P<0.001) and with donors from a nonlocal share distribution (10.6% versus 7.4% with donors with a local share distribution, P=0.004). The latter 2 findings held true in a multivariate analysis: the risk of HCC recurrence increased by 70% for recipients of livers from donors60 years old [subhazard ratio (SHR)=1.70, 95% confidence interval (CI)=1.31-2.20, P<0.001] and by 42% for recipients of nonlocal share distribution livers (SHR=1.42, 95% CI=1.09-1.84, P=0.009) after adjustments for clinical characteristics. In conclusion, the consideration of certain donor factors may reduce the cumulative incidence of posttransplant HCC recurrence and thus improve long-term survival after LT. Liver Transpl 21:187-194, 2015. (c) 2014 AASLD.