الفهرس 
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Abstract
SUMMARY
H
epatocellular carcinoma (HCC) is the most common primary malignancy of the liver and a major cause of mortality. Therapeutic treatment options are available for patients with local disease and include ablation, resection, and liver transplantation (LT). Liver transplantation (LT) is a recognized treatment choice for patients with cirrhosis of the liver and hepatocellular carcinoma (HCC). However, the greatest challenge in liver transplant is the shortage of donors that has contributed to a remarkable increase of the waiting lists.
A potential solution to the deceased donor organ shortage is to expand the organ donor pool to include live donation and to identify patients with lower rates of HCC recurrence to fairly allocate liver grafts. Our aims were to detect the long-term outcomes of living donor liver transplant (LDLT) versus deceased donor liver transplant (DDLT) for hepatocellular carcinoma (HCC) and the predictors of recurrence after transplantation.
According to 35 studies (7822 patients), the 1-, 3-, 4 year-OS showed trivial improvement for LDLT recipients. However, LDLT and DDLT recipients had similar 5-, 6- and 10-year OS. Moreover, our subgroup analysis showed equal long term OS between LDLT and DDLT for those who were within Milan criteria (MC). Nevertheless, beyond MC, there was a better prognosis for the patients who underwent LDLT.
In addition to that, a significant improvement in the ITT-OS was observed for LDLT recipients. Regarding the DFS and recurrence, these studies showed no significant difference between LDLT and DDLT. Moreover, the pooled hazard ratio of the included studies showed that MC, level of alfa fetoprotein (AFP), presence of vascular invasion (VI), tumor differentiation were predictors of recurrence.
CONCLUSION
T
his study is in consonance with the view that the cancer biology (not the graft type) is the most important determinant of recurrence and survival after LT. However, LDLT provided a much better survival benefits to HCC patients especially in regions that suffer from low deceased organ availability as it offers a unique opportunity of timely transplantation without competition and minimal waiting time.