title: Living donor liver transplantation in hepatocellular carcinoma beyond the Milan criteria.
abstract: OBJECTIVE
  In patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria, the recurrence rate after liver transplantation is over 50%. We investigated pretransplant factor(s) that could predict recurrence after living donor liver transplantation (LDLT) in patients with HCC exceeding the Milan criteria.
  
  
  METHODS
  Pre-operative imaging showed that, of the 111 HCC patients who underwent LDLT between June 1995 and January 2006, 37 exceeded the Milan criteria. Clinical factors before LDLT were evaluated.
  
  
  RESULTS
  The 1- and 3-year cumulative recurrence rates were 35 and 55% respectively. Pretransplant risk factors for HCC recurrence were large tumour size (>6 cm, P=0.001), tumour exposed to the liver surface (P=0.014) and progressive disease after pretransplant treatment (P=0.038). The 2-year HCC recurrence rates in patients with 0, 1, 2 and 3 factors were 0% (0/4), 9% (1/16), 80% (8/10) and 100% (7/7) respectively (P<0.001). The 2-year survival rate was significantly higher in patients with 0 or 1 factor than in patients with two or more factors (P=0.022).
  
  
  CONCLUSIONS
  In patients with HCC exceeding the Milan criteria, the three pretransplant factors that may be useful for identifying those with high HCC recurrence potential after LDLT are tumour size >6 cm, progressive disease after pretransplant treatment and tumour exposed to the liver surface.
authors.affiliation: Department of Internal Medicine, Liver Transplantation Center, Division of Hepatology, College of Medicine, The Catholic University of Korea, Seoul, Korea.
authors.forename: Hyun Young
authors.initials: HY
authors.lastname: Woo
authors.forename: Jeong Won
authors.initials: JW
authors.lastname: Jang
authors.forename: Jong Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Chan Ran
authors.initials: CR
authors.lastname: You
authors.forename: Soung Won
authors.initials: SW
authors.lastname: Jeong
authors.forename: Si Hyun
authors.initials: SH
authors.lastname: Bae
authors.forename: Seung Kew
authors.initials: SK
authors.lastname: Yoon
authors.forename: Young Sok
authors.initials: YS
authors.lastname: Lee
authors.forename: Dong Goo
authors.initials: DG
authors.lastname: Kim
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D004608:Eligibility Determination; D005260:Female; D006801:Humans; D007723:Korea / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors