Living-donor versus cadaveric liver transplantation for non-resectable small hepatocellular carcinoma and compensated cirrhosis: A decision analysis

• Published in: Transplantation Vol. 72; no. 5; pp. 861 - 868
• Main Authors: CHENG, Steve J, PRATT, Daniel S, FREEMAN, Richard B, KAPLAN, Marshall M, WONG, John B
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott 15-09-2001
• Subjects: Biological and medical sciences; Cadaver; Carcinoma, Hepatocellular - complications; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Decision Support Techniques; Humans; Life Expectancy; Liver Cirrhosis - complications; Liver Cirrhosis - surgery; Liver Neoplasms - complications; Liver Neoplasms - pathology; Liver Neoplasms - surgery; Liver Transplantation - methods; Liver Transplantation - mortality; Liver, biliary tract, pancreas, portal circulation, spleen; Living Donors; Markov Chains; Medical sciences; Middle Aged; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Tissue Donors; Human; Graft(material); Prognosis; Liver; Size; Living donor; Probability; Hepatocellular carcinoma; Risk; Transplantation; Homotransplantation; Survival; Retrospective; Blood; Cirrhosis; Advantage; Volume; Risk factor; Early; Tumor; Child; Comparative study; Organ
• ISSN: 0041-1337; 1534-6080
• DOI: 10.1097/00007890-200109150-00021

Cadaveric liver transplantation is effective for nonresectable early hepatocellular carcinoma. However, the scarcity of cadaveric organs has prompted some centers to use living donors, which guarantees transplantation, but entails a risk to the donor. In the absence of controlled trials, decision analysis can be used to help explicate the tradeoffs involved when considering living donor versus cadaveric liver transplantation for nonresectable early hepatocellular carcinoma.
Using a Markov model, a hypothetical cohort of patients with Child's A cirrhosis and a single 3.5-cm tumor received one of three strategies: 1) no transplant; 2) intent to perform cadaveric liver transplantation; or 3) living donor liver transplantation. Data were obtained from natural history and retrospective studies. All probabilities in the model were varied simultaneously using a Monte Carlo simulation.
Living-donor liver transplantation was the best strategy, improving life expectancy by 4.5 years compared with cadaveric liver transplantation. This strategy remained dominant even when varying severity of cirrhosis, age, tumor doubling time, tumor growth pattern, blood type, regional transplant volume, initial tumor size, and rate of progression of cirrhosis.
Living-donor liver transplantation should confer a substantial survival advantage for patients with compensated cirrhosis and non-resectable early stage hepatocellular carcinoma.