title: Liver transplant results for hepatocellular carcinoma applying strict preoperative selection criteria.
abstract: BACKGROUND
  Liver transplantation is currently the best therapeutic option for small hepatocellular carcinoma (HC) in selected cirrhotic patients. The main aim of this study was to analyze the results of a recent series of liver transplant cirrhotic patients with small HC applying strict preoperative selection criteria.
  
  
  METHODS
  During a period of 6 years we performed 53 liver transplants with a final diagnosis of HC on cirrhosis. The selection criteria for liver transplantation (LT) by modern imaging techniques were the Milan criteria (TNM I and II of the modified classification).
  
  
  RESULTS
  Of the 53 patients, 44 (83%) were transplanted with preoperatively known HC, and 9 (17%) with incidental HC. The mean time on the waiting list was 74 +/- 62 days. Despite using strict selection criteria, 23 patients (43%) exceeded the Milan criteria in the specimen and 17 (32%) even exceeded the extended criteria of the UCSF. With a mean follow-up of 2 years, only two patients have developed recurrences. The overall survival at 1, 3, and 5 years was 80%, 70%, and 70%, respectively. The survival of patients that exceeded the Milan or USF criteria at 1, 3, and 5 years was 72% and 76%; 67% and 69%; 67% and 69%, respectively.
  
  
  CONCLUSIONS
  The results of liver transplantation for HC are excellent when applying strict preoperative selection criteria. The current imaging methods lead to a considerable infrastaging percentage (30% to 40%), extending the indications for liver transplant due to HC beyond the scope that clinical reports would justify.
authors.affiliation: Hepatobiliary Surgery and Liver Transplant Unit, General and Digestive Surgery Department, Hospital Regional Universitario Carlos Haya, Malaga, Spain. jsantoyo@telefonica.net
authors.forename: J
authors.initials: J
authors.lastname: Santoyo
authors.forename: M A
authors.initials: MA
authors.lastname: Suarez
authors.forename: J L
authors.initials: JL
authors.lastname: Fernández-Aguilar
authors.forename: M
authors.initials: M
authors.lastname: Jiménez
authors.forename: J A
authors.initials: JA
authors.lastname: Perez Daga
authors.forename: B
authors.initials: B
authors.lastname: Sánchez-Perez
authors.forename: I
authors.initials: I
authors.lastname: Gonzalez Poveda
authors.forename: A
authors.initials: A
authors.lastname: Gonzalez-Sanchez
authors.forename: C
authors.initials: C
authors.lastname: Ramírez
authors.forename: A
authors.initials: A
authors.lastname: de la Fuente
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D004621:Embolization, Therapeutic; D000431:Ethanol / Q000627:therapeutic use; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation / Q000401:mortality / Q000502:physiology*; D009367:Neoplasm Staging; D018579:Patient Selection; D011300:Preoperative Care; D011846:Radio Waves; D012008:Recurrence; D016019:Survival Analysis
chemical_list: D000431:Ethanol