Can we expand the Milan criteria for hepatocellular carcinoma in living donor liver transplantation?
BACKGROUND
The Milan criteria, namely, tumors 5 cm or less in diameter in patients with single hepatocellular carcinoma (HCC), no more than 3 tumor nodules, and each 3 cm or less in diameter in patients with multiple tumors, are accepted for cadaveric liver allocation. However, in living donor liver transplantation (LDLT), graft donation may only depend on the donor's intention. The aim of this study was to elucidate the feasibility of Milan criteria in LDLT.


METHODS
From January 2001 to December 2002, 46 cases of liver transplantation (LT) for HCC included 5 hospital mortalities and 3 cadaveric transplantations, all of which were excluded. We classified the patients into Group I cases that met the Milan criteria and Group II cases that did not meet the Milan criteria. The analyses examined tumor-related risk factors affecting recurrence and survival, such as tumor size, number of tumor nodules, and presence of microvascular and macrovascular invasion.


RESULTS
Twenty-one cases belonged to Group I and 17 to Group II. There was no significant difference in the recurrence or survival rates between Groups I and II. The risk factors affecting recurrence were macrovascular invasion and tumor size (5 cm). The number of tumor nodules and microvascular invasion did not appear to affect recurrence. The risk factor affecting survival was macrovascular invasion.


CONCLUSIONS
We suggest that in selected cases the Milan criteria could be extended to increase the number of tumor nodules as long as the HCC were small and did not macrovascular invasion.
Lee
K W
KW
Department of Surgery, Division of Gastroenterology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Park
J W
JW
Joh
J W
JW
Kim
S J
SJ
Choi
S H
SH
Heo
J S
JS
Lee
H H
HH
Lee
D S
DS
Park
J H
JH
Yoo
B C
BC
Paik
S W
SW
Koh
K C
KC
Lee
J H
JH
Choi
M S
MS
Lee
S K
SK
D002102:Cadaver; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology / Q000706:statistics & numerical data*; D019520:Living Donors; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D014019:Tissue Donors