Living donor liver transplantation for hepatocellular carcinoma: a single-center experience in Taiwan.
BACKGROUND
Living donor liver transplantation (LDLT) demonstrates certain survival benefits over deceased donor liver transplantation for hepatocellular carcinoma (HCC) but there is no consensus on criteria for the use of LDLT for HCC for hepatocellular carcinoma (HCC) taking into account strategies to improve survival.


METHODS
Thirty-five patients (89% men) underwent LDLT for HCC. The mean age was 51 years (range, 22-61). The median disease severity scores were B, 11-20, and 2B for Child-Turcotte-Pugh, Model for End-stage Liver Disease, and United Network for Organ Sharing, respectively. The transplant records were retrospectively analyzed.


RESULTS
All were within Milan criteria at time of transplantation. A novel approach to downstaging tumors initially beyond the Milan criteria was evaluated using transarterial embolization or percutaneous ethanol injection. Our initial results were encouraging as recipients whose tumors had been downstaged had not had recurrence to date. Seven (20%) patients underwent hepatectomy for HCC before undergoing transplant. The overall mean posttransplant follow-up in this series was 40.3 months (range, 23-75). The overall posttransplant complication rate requiring intervention was 11%. There was only one malignancy recurrence for an overall recurrence rate of 3%. Vascular invasion and small- for-size transplants did not seem to influence tumor recurrence. The nonestimated recipient 1-year, 3-year, and 5-year survivals were 98%, 96%, and 90%, respectively.


CONCLUSIONS
This review emphasizes the need for early disease recognition and prompt intervention when Milan criteria are met to improve survival from HCC after LDLT.
Concejero
Allan
A
Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, and Chang Jung University College of Medicine Kaohsiung, Taiwan.
Chen
Chao-Long
CL
Wang
Chih-Chi
CC
Wang
Shih-Ho
SH
Lin
Chih-Che
CC
Liu
Yueh-Wei
YW
Yang
Chin-Hsiang
CH
Yong
Chee-Chien
CC
Lin
Tsan-Shiun
TS
Jawan
Bruno
B
Huang
Tung-Liang
TL
Cheng
Yu-Fan
YF
Eng
Hock-Liew
HL
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D016031:Liver Transplantation / Q000706:statistics & numerical data; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D013624:Taiwan / Q000453:epidemiology; D016896:Treatment Outcome