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Living donor liver transplantation as a second‐line therapeutic strategy for patients with hepatocellular carcinoma
Author(s) -
Takada Yasutsugu,
Ueda Mikiko,
Ito Takashi,
Sakamoto Seisuke,
Haga Hironori,
Maetani Yoji,
Ogawa Kohei,
Kasahara Mureo,
Oike Fumitaka,
Egawa Hiroto,
Tanaka Koichi
Publication year - 2006
Publication title -
liver transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.814
H-Index - 150
eISSN - 1527-6473
pISSN - 1527-6465
DOI - 10.1002/lt.20642
Subject(s) - medicine , hepatocellular carcinoma , liver transplantation , perioperative , milan criteria , surgery , liver disease , living donor liver transplantation , transplantation , gastroenterology
Living donor liver transplantation (LDLT) has evolved to represent an important surgical strategy for patients with hepatocellular carcinoma (HCC). However, due to disadvantages, including donor risks and higher rates of perioperative complications, LDLT has been considered as a second‐line treatment in Japan. The present study retrospectively evaluated clinical outcomes for 93 patients with HCC who underwent LDLT at our institute, including 44 patients who exceeded Milan criteria (MC). A total of 73 patients (78%) displayed a history of previous treatment for HCC using various nontransplant methods. Median follow‐up was 24 months (range, 1–76 months). At 4 years after LDLT, overall patient survival rate was 64%, with similar rates for within‐MC and over‐MC groups (68% vs. 59%, respectively; P = 0.6548). However, cumulative recurrence rate was significantly higher in the over‐MC group than in the within‐MC group (35% vs. 15%, P = 0.0190). Regarding history of conventional treatment for HCC before LDLT, patients who had received only 1–2 previous treatments showed significantly lower recurrence rates than patients with ≥3 treatments (9% vs. 37%, P = 0.0411). In conclusion, LDLT may constitute an optional treatment with a chance of cure for patients with otherwise uncontrolled disease. However, repeated nontransplant treatments for recurrent HCC prior to LDLT may increase the risk of recurrence and impair the survival advantages conferred by LDLT. Liver Transpl 12:912–919, 2006. © 2006 AASLD.