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

Experimental studies suggest that the regenerating liver provides a “fertile field” for the growth of hepatocellular carcinoma ( HCC ). However, clinical studies report conflicting results comparing living donor liver transplantation ( LDLT ) and deceased donor liver transplantation ( DDLT ) for HCC . Thus, disease‐free survival ( DFS ) and overall survival ( OS ) were compared after LDLT and DDLT for HCC in a systematic review and meta‐analysis. Twelve studies satisfied eligibility criteria for DFS , including 633 LDLT and 1232 DDLT . Twelve studies satisfied eligibility criteria for OS , including 637 LDLT and 1050 DDLT . 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 [ CI ]: 1.02–2.49; I 2  = 50.07%) for DFS after LDLT vs. DDLT for HCC , and 0.97 (95% CI : 0.73–1.27; I 2  = 5.68%) for OS. This analysis provides evidence of lower DFS after LDLT compared with DDLT for HCC . Improved study design and reporting is required in future research to ascribe the observed difference in DFS to study bias or biological risk specifically associated with LDLT .