Salvage living donor liver transplantation after prior liver resection for hepatocellular carcinoma.
Salvage liver transplantation has been performed for recurrent hepatocellular carcinoma (HCC) or deterioration of liver function after primary liver resection. Because prior liver resection per se is an unfavorable condition for living donor liver transplantation (LDLT), we assessed the technical feasibility of LDLT after prior hepatectomy, and we compared the outcome of salvage LDLT with that of primary LDLT in HCC patients. Of 342 patients with HCC, 17 (5%) underwent salvage LDLT, with 5 having undergone prior major liver resection and 12 prior minor resection. During salvage LDLT, 12 patients received right lobe grafts, 3 received left lobe grafts, and 2 received dual grafts. There was 1 incident (5.9%) of perioperative mortality. Recipient operation time was not prolonged in patients undergoing salvage LDLT, but bleeding complications occurred more frequently than in patients undergoing primary LDLT. Overall survival rates after salvage LDLT were similar to those after primary LDLT, especially when the extent of recurrent tumor was within the Milan criteria. These results indicate that every combination of prior hepatectomy and living donor liver graft is feasible for patients undergoing salvage LDLT, and the acceptable extent of HCC for salvage LDLT is equivalent to that for primary LDLT.
Hwang
Shin
S
Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
Lee
Sung-Gyu
SG
Moon
Deok-Bog
DB
Ahn
Chul-Soo
CS
Kim
Ki-Hun
KH
Lee
Young-Joo
YJ
Ha
Tae-Yong
TY
Song
Gi-Won
GW
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D006470:Hemorrhage / Q000209:etiology; D006498:Hepatectomy; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012086:Reoperation; D016879:Salvage Therapy