Risk factors impacting mortality after living related liver transplantation for hepatocellular carcinoma: a retrospective cohort study

Objective: Liver transplantation is an optimal form of radical therapy for selected patients with hepatocellular carcinoma (HCC). Yet, risk factors determining outcome after living donor liver transplantation (LDLT) are still lacking and need to be well identified to maximize recipient benefit and minimize donor risk. Aim: The aim of this study was to retrospectively identify and analyze the factors impacting mortality in HCC patients after LDLT. Patients and methods: This is a single-center retrospective analysis of data collected from 205 patients who underwent LDLT in the Department of Surgery, National Liver Institute, Menoufia University, between May 2004 and December 2013. Of these patients, 53 proved to have an HCC in the explanted liver. Preoperative data such as demographic criteria of the patients, liver status, tumor burden, and downstaging or bridging procedures, and all intraoperative and postoperative data were collected and compared against mortality outcome. Mortality was divided into three periods: hospital mortality, which occurred within 30 days after operation; early mortality, which occurred between 2 and 6 months postoperatively; and late mortality, which occurred 6 months after transplantation. Results: The mean age of all patients was 48±6.1 years; 50 (94.3%) patients were male. During the follow-up period, 22 (41.5%) patients died. The majority of mortality cases (10; 18.9%) were in the perioperative period; six (11.3%) patients died in the early period and six (11.3%) in the late period. There was a statistically significant relation between mortality rate and cytomegalovirus immunoglobulin (CMV-IgG) negativity and TNM classification (IIIB). Concerning the operative data, there was a significant statistical relation between mortality and actual graft weight, actual graft/ recipient weight ratio, and number of blood and plasma transfused units. Postoperatively, there was a significant statistical relation between mortality and the grade of tumor differentiation. In multivariate analysis, CMV-IgG negativity, TNM stage (stage III), actual graft weight, and number of blood transfusion units were independent predictors of mortality. Conclusion: Several factors have an independent significant effect on post-liver transplantation mortality. CMV-IgG negativity, advanced tumor stage (IIIB), actual graft weight, volume of intraoperative blood transfusion, poor tumor grade of differentiation, and tumor recurrence have an influence on post-transplantationmortality. Because LDLT can be performed regardless of Child–Pugh classification, model of end-stage liver disease score, and portal hypertension, only tumor factors, graft volume, and technical complications should be consideredwhen selectingHCCpatients forLDLT.