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Living donor liver transplantation in hepatocellular carcinoma beyond the Milan criteria

Authors

  • Hyun Young Woo,

    1. Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
    2. WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Jeong Won Jang,

    1. Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
    2. WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Jong Young Choi,

    1. Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
    2. WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Chan Ran You,

    1. Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
    2. WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Soung Won Jeong,

    1. Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
    2. WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Si Hyun Bae,

    1. Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
    2. WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Seung Kew Yoon,

    1. Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
    2. WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Young Sok Lee,

    1. Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
    2. WHO Collaborating Center on Viral Hepatitis, The Catholic University of Korea, Seoul, Korea
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  • Dong Goo Kim

    1. Department of Surgery, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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Correspondence
Jong Young Choi, MD, Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, #505 Banpodong, Seocho-ku, Seoul 137-040, Korea
Tel: +82 2 590 2529
Fax: +82 2 3481 4025.
e-mail: jychoi@catholic.ac.kr

Abstract

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.

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