ABO-incompatible Living Donor Liver Transplantation with Rituximab and Total Plasma Exchange Does Not Increase Hepatocellular Carcinoma Recurrence

ABSTRACTBackgroundABO-incompatible (ABO-I) living donor liver transplantation (LDLT) has a high success rate. This study compares HCC recurrence in ABO-I LDLT with that in ABO-compatible (ABO-C) LDLT and explores the effects of rituximab prophylaxis and total plasma exchange (TPE) on HCC recurrence after LDLT.MethodsTwo-hundred forty patients with a diagnosis of HCC underwent LDLT between 2010 and 2015. Fifty-nine patients underwent ABO-I LDLT.ResultsBaseline, perioperative, and tumor characteristics did not vary between the two groups. The 1-, 2-, and 3-year disease-free survival rates in the ABO-I LDLT and ABO-C LDLT groups were 90.3%, 79.7%, and 73.3% and 86.7%, 79.0%, and 75.3%, respectively (p=0.96). The overall patient survival rates for the same period in the ABO-I LDLT and ABO-C LDLT groups were 90.6%, 85.0%, and 81.9% and 88.0%, 83.5%, and 82.5%, respectively (p=0.77). HCC recurrence after LDLT was associated with preoperative alpha-fetoprotein >35 ng/mL, increased tumor size, encapsulation, and microvascular invasion. ABO-incompatibility was not related to HCC recurrence after LDLT.ConclusionsHCC recurrence and patient survival in the ABO-I LDLT group are comparable to those in the ABO-C LDLT group. Rituximab prophylaxis and TPE do not increase HCC recurrence after LT. Background ABO-incompatible (ABO-I) living donor liver transplantation (LDLT) has a high success rate. This study compares HCC recurrence in ABO-I LDLT with that in ABO-compatible (ABO-C) LDLT and explores the effects of rituximab prophylaxis and total plasma exchange (TPE) on HCC recurrence after LDLT. Methods Two-hundred forty patients with a diagnosis of HCC underwent LDLT between 2010 and 2015. Fifty-nine patients underwent ABO-I LDLT. Results Baseline, perioperative, and tumor characteristics did not vary between the two groups. The 1-, 2-, and 3-year disease-free survival rates in the ABO-I LDLT and ABO-C LDLT groups were 90.3%, 79.7%, and 73.3% and 86.7%, 79.0%, and 75.3%, respectively (p=0.96). The overall patient survival rates for the same period in the ABO-I LDLT and ABO-C LDLT groups were 90.6%, 85.0%, and 81.9% and 88.0%, 83.5%, and 82.5%, respectively (p=0.77). HCC recurrence after LDLT was associated with preoperative alpha-fetoprotein >35 ng/mL, increased tumor size, encapsulation, and microvascular invasion. ABO-incompatibility was not related to HCC recurrence after LDLT. Conclusions HCC recurrence and patient survival in the ABO-I LDLT group are comparable to those in the ABO-C LDLT group. Rituximab prophylaxis and TPE do not increase HCC recurrence after LT. Jong Man Kim: Design, literature search, data acquisition, analysis, interpretation and writing Jae-Won Joh: Design and data interpretation Heejin Yoo and Kyunga Kim: Data analysis and data interpretation David A. Gerber and Hiroto Egawa: Data interpretation and writing Sangbin Han, Dong Hyun Sinn, Gyu-Seong Choi, Choon Hyuck David Kwon, and Suk-Koo Lee: Acquisition and analysis of data Corresponding Author: Jae-Won Joh, M.D. Ph.D., Professor, Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Address: 81 Irwon-Ro, Gangnam-Gu, Seoul, Republic of Korea 06351, Telephone: 82-2-3410-3466, Fax: 82-2-3410-0040. E-mail: jongman94@hanmail.net Conflicts of Interest: The authors have no competing interests to declare. Financial Support: There is no current funding source for this study. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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