Living or deceased organ donors in liver transplantation for hepatocellular carcinoma: a systematic review and meta-analysis

Background: The outcomes of living donor liver transplantation (LDLT) versus deceased donor liver transplantation (DDLT) for HCC patients were not well defined and it was necessary to reassess. Methods: A comprehensive literature search was conducted in PubMed, Embase, Cochrane Library, Google Scholar and WanFang database for eligible studies. Perioperative and survival outcomes of HCC patients underwent LDLT were pooled and compared to those underwent DDLT. Results: Twenty-nine studies with 5376 HCC patients were included. For HCC patients underwent LDLT and DDLT, there were comparable rates of overall survival (OS) (1-year, RR = 1.04, 95% CI = 1.00-1.09, P = 0.03; 3-year, RR = 1.03, 95% CI = 0.96-1.11, P = 0.39; 5-year, RR = 1.04, 95% CI = 0.95-1.13, P = 0.43), disease free survival (DFS) (1-year, RR = 1.00, 95% CI = 0.95-1.05, P = 0.99; 3-year, RR = 1.00, 95% CI = 0.94-1.08, P = 0.89; 5-year, RR = 1.01, 95% CI = 0.93-1.09, P = 0.85), recurrence (1-year, RR = 1.41, 95% CI = 0.72-2.77, P = 0.32; 3-year, RR = 0.89, 95% CI = 0.57-1.39, P = 0.60; and 5-year, RR = 0.85, 95% CI = 0.56-1.31, P = 0.47), perioperative mortality within 3 months (RR = 0.89, 95% CI = 0.50-1.59, p = 0.70) and postoperative complication (RR = 0.99, 95% CI = 0.70-1.39, P = 0.94). LDLT was associated with better 5-year intention-to-treat patient survival (ITT-OS) than DDLT (RR = 1.11, 95% CI = 1.01-1.22, P = 0.04). Conclusion: This meta-analysis suggested that LDLT was not inferior to DDLT in consideration of comparable perioperative and survival outcomes. However, in terms of 5-year ITT-OS, LDLT was a possibly better choice for HCC patients.