Cross-Match as an Immuno-Oncological Risk Factor for Hepatocellular Carcinoma Recurrence and Inferior Survival After Living Donor Liver Transplantation: A Call for Further Investigation
Journal
Clinical Medicine Insights: Oncology
Journal Volume
14
Date Issued
2020
Abstract
Background: The success of immunotherapy for patients with hepatocellular carcinoma (HCC) suggests that immune dysregulation occurs in HCC patients. This warrants an immuno-oncological risk assessment in the platform of liver transplantation. Methods: This retrospective single-center study analyzed risk factors for—particularly cross-matching performed through conventional complement-dependent cytotoxicity cross-match tests—and the outcomes of HCC recurrence following living donor liver transplant. Results: A total of 71 patients were included. The median follow-up period was 29.1 months; 17 (23.9%) patients had posttransplant HCC recurrence, and their 1-, 3-, and 5-year-survival rates were 70.6%, 25.7%, and 17.1%, respectively, which were inferior to those of patients without HCC recurrence (87.0%, 80.7%, and 77.2%, respectively; P <.001). In addition to microvascular invasion, positive cross-match results for B cells at 37°C (B- 37°C) or T cells at 4°C (T- 4°C) were associated with inferior overall survival in multivariable analysis after adjustment for tumor status beyond Milan criteria and elevated alpha-fetoprotein levels. Rejection alone cannot be the mechanism underlying the effects of positive cross-match results on patient outcomes. Adjusted survival curves suggested that positive cross-match B- 37°C or T- 4°C was associated with inferior recurrence-free and patient survival, but the robustness of the finding was limited by insufficient power. Conclusions: Additional large-scale studies are required to validate positive cross-match as an immuno-oncological factor associated with HCC recurrence and inferior patient survival. ? The Author(s) 2020.
SDGs
Other Subjects
alpha fetoprotein; adult; Article; Asia; B lymphocyte; cancer patient; cancer recurrence; cancer risk; cancer survival; clinical outcome; controlled study; cytotoxicity; digestive system disease assessment; disease predisposition; female; follow up; HLA matching; human; liver cell carcinoma; liver graft rejection; liver transplantation; living donor; lymph vessel metastasis; major clinical study; male; middle aged; Milan criteria; multivariate analysis; overall survival; postoperative period; recurrence free survival; retrospective study; risk assessment; risk factor; survival rate; T lymphocyte
Publisher
SAGE Publications Ltd
Type
journal article