Detailed Abstract
[Poster Presentation 7 - Liver (Transplantation)]
[LV PP 7-S4] More Than 6 Times of Pretransplant Therapeutic Plasma Exchange Increase the Recurrence of Hepatocellular Carcinoma in ABO-incompatible Living Donor Liver Transplantation
Young Jin YOO 1, Deok-Gie KIM 2, Eun-Ki MIN 2, Seung Hyuk YIM 2, Mun Chae CHOI 2, Hwa-Hee KOH 2, Minyu KANG 2, Jae Geun LEE 2, Myoung Soo KIM 2, Dong Jin JOO 2
1 Department of Surgery, Graduate School of Medicine, Yonsei University College of Medicine, REPUBLIC OF KOREA, 2 Department of Surgery, Severance Hospital, REPUBLIC OF KOREA
Background : Previous studies reported comparable oncologic outcome in ABO-incompatible(ABOi) living donor liver transplantation(LDLT) with that in ABO-compatible(ABOc) LDLT in hepatocellular carcinoma(HCC) patients. We aimed to analyze the relationship between the number of therapeutic plasma exchange(TPE) and HCC outcomes in ABOi LDLT.
Methods : In this single center retrospective study, 503 adult LDLT recipients with HCC were categorized into three groups according to ABO incompatibility and the number of pretransplant TPE, of which cutoff was more than 6 times, determined from cubic spline model for recurrence-free survival(RFS); ABOc (n=398), ABOi/TPE≤5 (n=77), and ABOi/TPE≥6 (n=28). RFS and HCC recurrence were compared with adjusting other risk factors for HCC outcomes.
Results : Three groups showed similar characteristics in most demographics, pretransplant tumor markers and tumor pathologies. The median of isoagglutinin titer before desensitization was 1:64 (range negative-1:512) in the ABOi/TPE≤5 group and 1:512 (range 1:128-1:4096) in ABOi/TPE≥6 group. Five-year RFS was significantly lower (74.4% in the ABOc group vs. 73.1% in the ABOi/TPE≤5 group vs. 48.7% in the ABOi/TPE≥6, P=0.003) and HCC recurrence was significantly higher in the ABOi/TPE≥6 group than the others (16.1% vs. 16.9% vs. 40.0%, P=0.006). In multivariable Cox regression, ABOi/TPE≥6 was independent risk factor for RFS (aHR 1.97, 95% CI 1.03-3.79, P=0.041) and HCC recurrence (aHR 2.54, 95% CI 1.11-5.82, P=0.028).
Conclusions : More than 6 times of pretransplant TPE has a potential of higher HCC recurrence after ABOi LDLT. Strategy to reduce the number of TPE less than 5 would be needed when planning ABOi LDLT for HCC patients, ensuring similar immunologic risk.
Methods : In this single center retrospective study, 503 adult LDLT recipients with HCC were categorized into three groups according to ABO incompatibility and the number of pretransplant TPE, of which cutoff was more than 6 times, determined from cubic spline model for recurrence-free survival(RFS); ABOc (n=398), ABOi/TPE≤5 (n=77), and ABOi/TPE≥6 (n=28). RFS and HCC recurrence were compared with adjusting other risk factors for HCC outcomes.
Results : Three groups showed similar characteristics in most demographics, pretransplant tumor markers and tumor pathologies. The median of isoagglutinin titer before desensitization was 1:64 (range negative-1:512) in the ABOi/TPE≤5 group and 1:512 (range 1:128-1:4096) in ABOi/TPE≥6 group. Five-year RFS was significantly lower (74.4% in the ABOc group vs. 73.1% in the ABOi/TPE≤5 group vs. 48.7% in the ABOi/TPE≥6, P=0.003) and HCC recurrence was significantly higher in the ABOi/TPE≥6 group than the others (16.1% vs. 16.9% vs. 40.0%, P=0.006). In multivariable Cox regression, ABOi/TPE≥6 was independent risk factor for RFS (aHR 1.97, 95% CI 1.03-3.79, P=0.041) and HCC recurrence (aHR 2.54, 95% CI 1.11-5.82, P=0.028).
Conclusions : More than 6 times of pretransplant TPE has a potential of higher HCC recurrence after ABOi LDLT. Strategy to reduce the number of TPE less than 5 would be needed when planning ABOi LDLT for HCC patients, ensuring similar immunologic risk.
SESSION
Poster Presentation 7
Zone A 3/22/2024 2:50 PM - 3:40 PM