Liver Transplantation in Patients With Hepatocarcinoma. Does the Donor Characteristics Influence the Risk of Tumor Recurrence and Survival?

[BACKGROUND] The shortage of ideal liver donors (ID) has led to increased use of marginal donors (MD), characterized by factors such as advanced age, macrosteatosis, anti-HBc positivity, or controlled donation after circulatory death. In hepatocellular carcinoma (HCC), this raises concerns regarding tumor recurrence and post-transplant survival.

[METHODS] A retrospective, single-center observational study was conducted, including all patients transplanted for HCC between 2010 and 2023. Patients were classified into two groups: ID and MD, with MD defined by at least 1 marginality criterion. Survival analyses were performed using Kaplan-Meier curves, and statistical significance was set at P < .05.

[RESULTS] Of 99 patients, 76% received grafts from MD. Among MD, 31.3% derived from circulatory death donors and 53.5% were over 60 years old. No significant differences were found in biliary or vascular complication rates between groups. Tumor recurrence occurred in 7 patients-6 in the MD group-but without statistical significance in disease-free survival (P = .79). Overall survival at 12, 24, and 36 months was 72%, 63%, and 58% for ID vs 92%, 80%, and 74% for MD, respectively (P = .06).

[CONCLUSIONS] In this series, liver grafts from marginal donors were not associated with higher recurrence rates or reduced survival in HCC patients compared to ideal donors. Although larger, multicenter studies are needed to confirm these findings, the use of MD may safely increase organ availability without compromising clinical outcomes.