Donor characteristics and risk of hepatocellular carcinoma recurrence after liver transplantation

BackgroundTo date, studies assessing the risk of post-transplant hepatocellular carcinoma (HCC) recurrence have focused on tumour characteristics. This study investigated the impact of donor characteristics and graft quality on post-transplant HCC recurrence. MethodsUsing the Scientific Registry of Transplant Recipients patients with HCC who received a liver transplant between 2004 and 2011 were included, and post-transplant HCC recurrence was assessed. A multivariable competing risk regression model was fitted, adjusting for confounders such as recipient sex, age, tumour volume, -fetoprotein, time on the waiting list and transplant centre. ResultsA total of 9724 liver transplant recipients were included. Patients receiving a graft procured from a donor older than 60 years (adjusted hazard ratio (HR) 138, 95 per cent c.i. 110 to 173; P = 0006), a donor with a history of diabetes (adjusted HR 143, 111 to 183; P = 0006) and a donor with a body mass index of 35kg/m(2) or more (adjusted HR 136, 104 to 177; P = 0023) had an increased rate of post-transplant HCC recurrence. In 3007 patients with documented steatosis, severe graft steatosis (more than 60 per cent) was also linked to an increased risk of recurrence (adjusted HR 165, 103 to 264; P = 0037). Recipients of organs from donation after cardiac death donors with prolonged warm ischaemia had higher recurrence rates (adjusted HR 426, 120 to 151; P = 0025). ConclusionDonor-related factors such as donor age, body mass index, diabetes and steatosis are associated with an increased rate of HCC recurrence after liver transplantation. Donor characteristics are important