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Living donor liver transplantation in hepatocellular carcinoma beyond the Milan criteria
Author(s) -
Woo Hyun Young,
Jang Jeong Won,
Choi Jong Young,
You Chan Ran,
Jeong Soung Won,
Bae Si Hyun,
Yoon Seung Kew,
Lee Young Sok,
Kim Dong Goo
Publication year - 2008
Publication title -
liver international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.873
H-Index - 110
eISSN - 1478-3231
pISSN - 1478-3223
DOI - 10.1111/j.1478-3231.2008.01785.x
Subject(s) - milan criteria , medicine , hepatocellular carcinoma , liver transplantation , gastroenterology , risk factor , carcinoma , liver disease , survival rate , transplantation , surgery
Background/Aims: In patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria, the recurrence rate after liver transplantation is over 50%. We investigated pretransplant factor(s) that could predict recurrence after living donor liver transplantation (LDLT) in patients with HCC exceeding the Milan criteria. Methods: Pre‐operative imaging showed that, of the 111 HCC patients who underwent LDLT between June 1995 and January 2006, 37 exceeded the Milan criteria. Clinical factors before LDLT were evaluated. Results: The 1‐ and 3‐year cumulative recurrence rates were 35 and 55% respectively. Pretransplant risk factors for HCC recurrence were large tumour size (>6 cm, P =0.001), tumour exposed to the liver surface ( P =0.014) and progressive disease after pretransplant treatment ( P =0.038). The 2‐year HCC recurrence rates in patients with 0, 1, 2 and 3 factors were 0% (0/4), 9% (1/16), 80% (8/10) and 100% (7/7) respectively ( P <0.001). The 2‐year survival rate was significantly higher in patients with 0 or 1 factor than in patients with two or more factors ( P =0.022). Conclusions: In patients with HCC exceeding the Milan criteria, the three pretransplant factors that may be useful for identifying those with high HCC recurrence potential after LDLT are tumour size >6 cm, progressive disease after pretransplant treatment and tumour exposed to the liver surface.