Orthotopic liver transplantation provides a survival advantage compared with resection in patients with hepatocellular carcinoma and preserved liver function.

Abstract

Prior studies comparing the efficacy of orthotopic liver transplantation to resection in patients with hepatocellular carcinoma have not controlled for underlying severity of liver disease. Patients with stage I to III hepatocellular carcinoma and preserved liver function (model for end-stage liver disease <12) who underwent resection or orthotopic liver transplantation between 2010 and 2013 were identified from the National Cancer Database. Short-term (30- and 90-day) and overall survival were assessed from 1:1 propensity score-matched cohorts based on patient and tumor characteristics. During the period studied, 689 (28%) underwent orthotopic liver transplantation, and 1,774 (72%) patients underwent resection. Propensity score matching yielded 374 undergoing orthotopic liver transplantation matched to 374 patients undergoing resection. Rates of 30-day mortality (01.9% vs 0.8%, respectively; P = .34) and 90-day mortality (3.5% vs 2.1%, P = .38) were not different between matched cohorts. Orthotopic liver transplantation did, however, result in a greater overall survival compared with resection (median overall survival not reached versus 4.5 years; P = .01). On multivariable Cox regression, resection was associated with a 67% greater likelihood of overall mortality compared with orthotopic liver transplantation (hazard ratio 1.67; 95% confidence interval, 1.15-2.43). For patients diagnosed with hepatocellular carcinoma in the context of preserved liver function, orthotopic liver transplantation was associated with a significant improvement in overall survival relative to resection.