Living vs. deceased donor liver transplantation for hepatocellular carcinoma: a systematic review and meta‐analysis

<jats:title>Abstract</jats:title><jats:p>Experimental studies suggest that the regenerating liver provides a “fertile field” for the growth of hepatocellular carcinoma (<jats:styled-content style="fixed-case">HCC</jats:styled-content>). However, clinical studies report conflicting results comparing living donor liver transplantation (<jats:styled-content style="fixed-case">LDLT</jats:styled-content>) and deceased donor liver transplantation (<jats:styled-content style="fixed-case">DDLT</jats:styled-content>) for <jats:styled-content style="fixed-case">HCC</jats:styled-content>. Thus, disease‐free survival (<jats:styled-content style="fixed-case">DFS</jats:styled-content>) and overall survival (<jats:styled-content style="fixed-case">OS</jats:styled-content>) were compared after <jats:styled-content style="fixed-case">LDLT</jats:styled-content> and <jats:styled-content style="fixed-case">DDLT</jats:styled-content> for <jats:styled-content style="fixed-case">HCC</jats:styled-content> in a systematic review and meta‐analysis. Twelve studies satisfied eligibility criteria for <jats:styled-content style="fixed-case">DFS</jats:styled-content>, including 633 <jats:styled-content style="fixed-case">LDLT</jats:styled-content> and 1232 <jats:styled-content style="fixed-case">DDLT</jats:styled-content>. Twelve studies satisfied eligibility criteria for <jats:styled-content style="fixed-case">OS</jats:styled-content>, including 637 <jats:styled-content style="fixed-case">LDLT</jats:styled-content> and 1050 <jats:styled-content style="fixed-case">DDLT</jats:styled-content>. Altogether, there were 16 unique studies; 1, 2, and 13 of these were rated as high, medium, and low quality, respectively. Studies were heterogeneous, non‐randomized, and mostly retrospective. The combined hazard ratio was 1.59 (95% confidence interval [<jats:styled-content style="fixed-case">CI</jats:styled-content>]: 1.02–2.49; <jats:italic>I</jats:italic><jats:sup>2</jats:sup> = 50.07%) for <jats:styled-content style="fixed-case">DFS</jats:styled-content> after <jats:styled-content style="fixed-case">LDLT</jats:styled-content> vs. <jats:styled-content style="fixed-case">DDLT</jats:styled-content> for <jats:styled-content style="fixed-case">HCC</jats:styled-content>, and 0.97 (95% <jats:styled-content style="fixed-case">CI</jats:styled-content>: 0.73–1.27; <jats:italic>I</jats:italic><jats:sup>2 </jats:sup>= 5.68%) for OS. This analysis provides evidence of lower <jats:styled-content style="fixed-case">DFS</jats:styled-content> after <jats:styled-content style="fixed-case">LDLT</jats:styled-content> compared with <jats:styled-content style="fixed-case">DDLT</jats:styled-content> for <jats:styled-content style="fixed-case">HCC</jats:styled-content>. Improved study design and reporting is required in future research to ascribe the observed difference in <jats:styled-content style="fixed-case">DFS</jats:styled-content> to study bias or biological risk specifically associated with <jats:styled-content style="fixed-case">LDLT</jats:styled-content>.</jats:p>