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Macrovascular invasion is not an absolute contraindication for living donor liver transplantation
Author(s) -
Lee KwangWoong,
Suh SukWon,
Choi YoungRok,
Jeong Jaehong,
Yi NamJoon,
Kim Hyeyoung,
Yoon Kyung Chul,
Hong Suk Kyun,
Kim HyoSin,
Lee KyungBun,
Suh KyungSuk
Publication year - 2017
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.24610
Subject(s) - medicine , contraindication , liver transplantation , hepatocellular carcinoma , milan criteria , transplantation , gastroenterology , living donor liver transplantation , surgery , pathology , alternative medicine
The indication of liver transplantation (LT) for the treatment of advanced hepatocellular carcinoma (HCC) is expanding. However, portal vein tumor thrombus (PVTT) has been still accepted as an absolute contraindication. We experienced an unexpectedly good prognosis in selected patients. Therefore, we tried to identify the prognostic factors after LT for HCC with major PVTT. Among 282 patients who underwent living donor liver transplantation (LDLT) for HCC from January 2009 to December 2013, 11 (3.9%) patients with major PVTT that was preoperatively diagnosed were investigated. The 1‐, 3‐, and 5‐year recurrence‐free survival rates were 63.6%, 45.5%, and 45.5%, respectively, and all recurrent cases showed intrahepatic and extrahepatic recurrence. The 1‐, 3‐, and 5‐year overall survival rates were 72.7%, 63.6%, and 63.6%, respectively, and 2 patients with delayed recurrence survived approximately 5 years after LT. Main portal vein (PV) invasion ( P < 0.01), high alpha‐fetoprotein × protein induced by vitamin K absence/antagonist‐II (AP) score (≥20,000; P < 0.01), high standardized uptake value (SUV) ratio (tumor/background liver) in positron emission tomography (≥2.1; P < 0.01), and a large original tumor (≥7 cm; P = 0.03) were significant risk factors for recurrence. In conclusion, if the PVTT has not expanded to the main PV and the AP score is not high, we can consider LDLT as a curative treatment option. Liver Transplantation 23:19–27 2017 AASLD .