Post-transplant oncologic outcomes after locoregional downstaging before living donor liver transplantation for hepatocellular carcinoma beyond Milan criteria: a systematic review and meta-analysis of selected cohorts
- 1Department of Surgery, Chonnam National University Medical School and Hospital , ,
Abstract
Downstaging of hepatocellular carcinoma (HCC) before liver transplantation is established mainly in the deceased donor setting, and outcomes before living donor liver transplantation (LDLT) remain unclear. We searched PubMed and Embase through April 2026 for studies reporting post-transplant outcomes in patients with HCC beyond Milan criteria who were downstaged before LDLT. A pre-specified primary analysis covered locoregional therapy targeting Milan or UCSF criteria. We pooled proportions using random-effects models and reconstructed patient-level survival from Kaplan-Meier curves. Seventeen studies with 511 downstaged LDLT recipients were included. In the primary cohort, recurrence was 22.1% (95% CI 9.7–42.6) and 5-year overall survival 75.8% (61.8–85.8). Across all studies, recurrence was 25.0% (17.4–34.5), 5-year overall survival 75.0% (63.1–84.1), and downstaging success 47.5% (36.1–59.1); reconstructed 5-year overall and recurrence-free survival were 75.7% and 75.6%. These estimates describe patients who achieved downstaging—fewer than half of those who attempted it—and then reached transplant. They do not measure the benefit of downstaging itself. The evidence remains retrospective and mostly Asian, with wide variation between studies. Prospective intention-to-treat studies are needed.
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BibTeX
@article{jo2026posttransplant,
title = {{Post-transplant oncologic outcomes after locoregional downstaging before living donor liver transplantation for hepatocellular carcinoma beyond Milan criteria: a systematic review and meta-analysis of selected cohorts}},
author = {Younggoun Jo and Yunchul Park and Ho-Kyun Lee and Sola Lee and Hong-Sung Jung and Soo Jin Na Choi and Hyo-Sin Kim},
journal = {Transplant international : official journal of the European Society for Organ Transplantation},
year = {2026},
month = oct,
doi = {10.3389/ti.2026.17284},
url = {https://europepmc.org/article/PMC/PMC13727510},
note = {CC BY},
}
RIS
TY - JOUR
TI - Post-transplant oncologic outcomes after locoregional downstaging before living donor liver transplantation for hepatocellular carcinoma beyond Milan criteria: a systematic review and meta-analysis of selected cohorts
AU - Younggoun Jo
AU - Yunchul Park
AU - Ho-Kyun Lee
AU - Sola Lee
AU - Hong-Sung Jung
AU - Soo Jin Na Choi
AU - Hyo-Sin Kim
PY - 2026
DA - 2026/10/20
JO - Transplant international : official journal of the European Society for Organ Transplantation
DO - 10.3389/ti.2026.17284
UR - https://europepmc.org/article/PMC/PMC13727510
AB - Downstaging of hepatocellular carcinoma (HCC) before liver transplantation is established mainly in the deceased donor setting, and outcomes before living donor liver transplantation (LDLT) remain unclear. We searched PubMed and Embase through April 2026 for studies reporting post-transplant outcomes in patients with HCC beyond Milan criteria who were downstaged before LDLT. A pre-specified primary analysis covered locoregional therapy targeting Milan or UCSF criteria. We pooled proportions using random-effects models and reconstructed patient-level survival from Kaplan-Meier curves. Seventeen studies with 511 downstaged LDLT recipients were included. In the primary cohort, recurrence was 22.1% (95% CI 9.7–42.6) and 5-year overall survival 75.8% (61.8–85.8). Across all studies, recurrence was 25.0% (17.4–34.5), 5-year overall survival 75.0% (63.1–84.1), and downstaging success 47.5% (36.1–59.1); reconstructed 5-year overall and recurrence-free survival were 75.7% and 75.6%. These estimates describe patients who achieved downstaging—fewer than half of those who attempted it—and then reached transplant. They do not measure the benefit of downstaging itself. The evidence remains retrospective and mostly Asian, with wide variation between studies. Prospective intention-to-treat studies are needed.
SN - 0934-0874
SN - 1432-2277
ER -