HCC in living donor liver transplantation: can we expand the Milan criteria?
BACKGROUND
The tumor biology of hepatocellular carcinoma (HCC) affects recurrence after liver transplantation (LT), but most selection guidelines are based only on tumor size and number. The aim of the study is to evaluate the possibility of expanding the selection criteria in living donor LT (LDLT) without compromising patient survival by adding alpha-fetoprotein (AFP) in selection guideline.


METHODS
One hundred thirty-nine patients who received LDLT with the diagnosis of HCC and survived more than 3 months were enrolled. The operability was based on Milan criteria but LT beyond the criteria was performed when requested by the patients and/or the guardian after thorough explanation.


RESULTS
The median follow-up duration was 28 months. One-, three- and five-year survival rates were 92.2, 82.6, and 79.9%. There was no survival difference between patients within or beyond Milan (p = 0.76). Serum AFP level >400 ng/ml, tumor size >5 cm, and vascular invasion were significant on univariate analysis, but only vascular invasion was significant on multivariate analysis (p = 0.007). Patients with >3 tumor nodules had better survival compared to <or=3 nodules (p = 0.196). Patient selection using tumor size <or=5 cm and AFP <or=400 ng/ml without limitation of tumor numbers could expand patient selection and improve patient survival.


CONCLUSIONS
Application of serum AFP level to selection of HCC for LT affords better patient selection criteria.
Kwon
Choon Hyuck David
CH
Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
Kim
Doo Jin
DJ
Han
Young Seok
YS
Park
Jae Berm
JB
Choi
Gyu Seong
GS
Kim
Sung Joo
SJ
Joh
Jae Won
JW
Lee
Suk-Koo
SK
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000145:classification / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local / Q000097:blood / Q000453:epidemiology; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D000509:alpha-Fetoproteins / Q000032:analysis
D000509:alpha-Fetoproteins