Small-sized liver graft does not increase the risk of hepatocellular carcinoma recurrence after living donor liver transplantation

Purpose. Following implantation into adult recipients, living donor liver grafts usually undergo liver regeneration. This regeneration process may provoke the growth of occult hepatocellular carcinoma (HCC) cells in the recipient body. To assess the risk of HCC recurrence, we analyzed the influence of graft-recipient weight ratio (GRWR). Methods. The 181 recipients with HCC within the University of California at San Francisco (UCSF) criteria were divided into four groups according to GRWR: low GRWR (< 0.8; n = 30), mid GRWR (0.8-1.0; n = 65), high GRWR (> 1.0; n = 64), and whole liver graft group (> 1.5; n = 22). Results. There were no differences in overall patient survival (P = .105) and recurrence-free survival (P = .406) among these four groups. GRWR < 0.8 was not a significant risk factor for HCC recurrence. Similar outcomes were obtained in HCC patients who met the Milan criteria (n = 170). Conclusions. We think that small living donor liver graft and subsequent liver regeneration do not increase the risk of posttransplant HCC recurrence when HCC is within the Milan or UCSF criteria.