Living donor liver transplantation in hepatocellular carcinoma beyond the Milan criteria
Article first published online: 20 MAY 2008
© 2008 The Authors. Journal compilation © 2008 Blackwell Munksgaard
Volume 28, Issue 8, pages 1120–1128, September 2008
How to Cite
Woo, H. Y., Jang, J. W., Choi, J. Y., You, C. R., Jeong, S. W., Bae, S. H., Yoon, S. K., Lee, Y. S. and Kim, D. G. (2008), Living donor liver transplantation in hepatocellular carcinoma beyond the Milan criteria. Liver International, 28: 1120–1128. doi: 10.1111/j.1478-3231.2008.01785.x
- Issue published online: 6 AUG 2008
- Article first published online: 20 MAY 2008
- Received 3 December 2007Accepted 5 April 2008
- hepatocellular carcinoma;
- liver transplantation;
- Milan criteria
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.