Comparative Review of LDLT and DDLT Outcomes in Hepatocellular Carcinoma Patients

Hepatocellular carcinoma (HCC) remains one of the most common and deadly cancers globally. Hepatocellular carcinoma (HCC) is the most common primary liver malignancy and a leading cause of cancer-related mortality worldwide, particularly in regions with high prevalence of viral hepatitis. Liver transplantation (LT) offers a curative option for select HCC patients by treating both the tumor and underlying liver disease. Deceased donor liver transplantation (DDLT) has traditionally been the gold standard; however, its effectiveness is limited by organ shortages, long waitlist times, and the risk of tumor progression beyond transplant criteria. Living donor liver transplantation (LDLT) has emerged as a viable alternative that can significantly reduce wait times, particularly in regions with limited access to deceased donor organs. While LDLT offers logistical and timing advantages, concerns remain regarding possible differences in long-term survival, recurrence risk, and the impact of partial grafts on tumor biology. A direct comparison of LDLT and DDLT outcomes in HCC patients remains critical to informing transplant decision-making. To compare overall survival (OS), intention-to-treat overall survival (ITT-OS), disease-free survival (DFS), and recurrence rates in HCC patients undergoing LDLT versus DDLT.