title: Living donor liver transplantation for hepatocellular carcinoma: a single-center experience in Taiwan.
abstract: 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.
authors.affiliation: Liver Transplantation Program, Chang Gung Memorial Hospital-Kaohsiung Medical Center, and Chang Jung University College of Medicine Kaohsiung, Taiwan.
authors.forename: Allan
authors.initials: A
authors.lastname: Concejero
authors.forename: Chao-Long
authors.initials: CL
authors.lastname: Chen
authors.forename: Chih-Chi
authors.initials: CC
authors.lastname: Wang
authors.forename: Shih-Ho
authors.initials: SH
authors.lastname: Wang
authors.forename: Chih-Che
authors.initials: CC
authors.lastname: Lin
authors.forename: Yueh-Wei
authors.initials: YW
authors.lastname: Liu
authors.forename: Chin-Hsiang
authors.initials: CH
authors.lastname: Yang
authors.forename: Chee-Chien
authors.initials: CC
authors.lastname: Yong
authors.forename: Tsan-Shiun
authors.initials: TS
authors.lastname: Lin
authors.forename: Bruno
authors.initials: B
authors.lastname: Jawan
authors.forename: Tung-Liang
authors.initials: TL
authors.lastname: Huang
authors.forename: Yu-Fan
authors.initials: YF
authors.lastname: Cheng
authors.forename: Hock-Liew
authors.initials: HL
authors.lastname: Eng
mesh_terms: 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