Living donor liver transplantation for Barcelona clinic liver cancer (BCLC) intermediate-stage hepatocellular carcinoma

Ming Chao Tsai; Chee-Chien Yong; Chih-Che Lin; Wei-Chen Lee; Chih-Chi Wang; Chao-Hung Hung; I-Hsuan Chen; Yu-Fan Cheng; Chang-Chun Hsiao; Tsung-Hui Hu; Chao-Long Chen

doi:10.21037/hbsn-21-196

Living donor liver transplantation for Barcelona clinic liver cancer (BCLC) intermediate-stage hepatocellular carcinoma

Hepatobiliary Surg Nutr. 2023 Apr 10;12(2):169-182. doi: 10.21037/hbsn-21-196. Epub 2022 Mar 11.

Authors

Affiliations

¹ Division of Hepato-Gastroenterology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung.
² School of Medicine, College of Medicine, National Sun Yat-sen University, Kaohsiung.
³ Liver Transplantation Center and Department of Surgery, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung.
⁴ Division of Liver and Transplantation Surgery, Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Taoyuan.
⁵ Liver Transplantation Center and Department of Diagnostic Radiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung.
⁶ Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University, Division of Pulmonary and Critical Care Medicine, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung.

Abstract

Background: Barcelona clinic liver cancer (BCLC) stage B (intermediate stage) hepatocellular carcinoma (HCC) is highly heterogeneous; thus, identifying the most effective treatment for individual patients represents a significant clinical challenge. However, transarterial chemoembolization (TACE) is the only recommended treatment option. Therefore, we aimed to investigate the patient characteristics and outcomes of living donor liver transplantation (LDLT) for BCLC stage B HCC.

Methods: A total of 516 patients with BCLC stage B HCC who underwent LDLT (n=104) or did not undergo LDLT (non-LDLT; n=412) between 2004 to 2018 were analyzed by propensity score matching (PSM; 1:4) analysis. Factors influencing overall survival (OS) and recurrence were analyzed using Cox's proportional hazards models.

Results: Patients treated with LDLT achieved better OS than the non-LDLT group, including liver- and non-liver related survival (all P<0.001). Multivariate Cox regression analysis showed age >60 years (P=0.006), a neutrophil-lymphocyte ratio (NLR) >4 (P=0.016) and >3 locoregional therapies (LRT) before LDLT (P<0.001) were independent risk factors for HCC recurrence. In addition, age >60 years (P<0.001) and >3 LRT before LDLT (P=0.001) were independent risk factors for OS. Using a combination of age, NLR, and LRT before liver transplantation (LT), the patients can be divided into low-risk (none of risk), intermediate-risk (one of risk), and high risk (more than two of risk) groups. There were significant differences in the cumulative HCC recurrence (P<0.001) and mortality (P<0.001) rates among the three groups.

Conclusions: LDLT may represent a valuable therapeutic option for selected patients with BCLC stage B HCC.

Keywords: Barcelona clinic liver cancer stage B (BCLC stage B); Living donor liver transplantation (LDLT); hepatocellular carcinoma (HCC); intermediate stage.