Bos, M.D. (2020) The effect of liver graft steatosis and donation after cardiac death on hepatocellular carcinoma recurrence following liver transplantation A systematic review and meta-analysis. thesis, Medicine.
Full text available on request.Abstract
Background: Due to the growing organ shortage, lower quality liver grafts or “extended criteria donor” (ECD) livers are increasingly being accepted for transplantation worldwide. Examples of ECD livers are steatotic livers and livers obtained from donation after circulatory death (DCD) donors. A disadvantage of these suboptimal livers is their increased susceptibility to ischemia-reperfusion (I/R) injury. There is growing evidence that I/R injury is oncogenic and that it plays a role in the recurrence of hepatocellular carcinoma (HCC) following liver transplantation (LT). Therefore, a systematic review and meta-analysis was conducted to determine the effect of liver graft steatosis and DCD-LT on the development of post-transplant HCC recurrence. Methods: The literature (PubMed, Embase and Cochrane) was systematically searched to May 2020 for studies assessing the association between HCC recurrence and the transplantation of steatotic livers or livers procured from DCD donors in adult LT patients. Study selection and data extraction was performed by one researcher. The methodological quality and risk of bias of included studies were assessed using the NOS and OCEBM criteria. For inclusion in the meta-analysis, hazard ratios (HRs) with the corresponding 95% confidence intervals (CIs) served as effect measures and these were displayed in a forest plot. The risk of publication bias was shown in a funnel plot. Results: Among 415 studies, seven studies fulfilled the inclusion criteria. Three studies evaluated the impact of liver graft steatosis (mild: <30%, moderate: 30-60% or severe: >60%) on HCC recurrence, with varying results. Among the six studies that assessed the effect of DCD-LT on the recurrence of HCC following transplantation, meta-analysis showed a pooled HR of 1.01 (95% confidence interval 0.95-1.07, P=0.81). Conclusion: Moderate and severe graft steatosis may increase the risk of post-transplant HCC recurrence, while DCD-LT was not found to be associated with tumor recurrence in HCC patients. Thus, allocating selected marginal liver grafts to patients with HCC could potentially decrease the shortage of donor livers, whilst still maintaining acceptable oncological outcomes. However, because evidence is still limited, interpretation of these results must be approached with caution.
| Item Type: | Thesis (UNSPECIFIED) |
|---|---|
| Supervisor name: | Hoogwater, dr. F.J.H. |
| Faculty: | Medical Sciences |
| Date Deposited: | 28 Aug 2023 11:10 |
| Last Modified: | 28 Aug 2023 11:10 |
| URI: | https://umcg.studenttheses.ub.rug.nl/id/eprint/3651 |
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