title: HCC in living donor liver transplantation: can we expand the Milan criteria?
abstract: 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.
authors.affiliation: Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
authors.forename: Choon Hyuck David
authors.initials: CH
authors.lastname: Kwon
authors.forename: Doo Jin
authors.initials: DJ
authors.lastname: Kim
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Han
authors.forename: Jae Berm
authors.initials: JB
authors.lastname: Park
authors.forename: Gyu Seong
authors.initials: GS
authors.lastname: Choi
authors.forename: Sung Joo
authors.initials: SJ
authors.lastname: Kim
authors.forename: Jae Won
authors.initials: JW
authors.lastname: Joh
authors.forename: Suk-Koo
authors.initials: SK
authors.lastname: Lee
mesh_terms: 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
chemical_list: D000509:alpha-Fetoproteins