Liberal policy in living donor liver transplantation for hepatocellular carcinoma: lessons learned.
BACKGROUND
Living donor liver transplantation (LDLT) in cases of hepatocellular carcinoma (HCC) that do not fulfil accepted tumor criteria continues to be a matter of controversy. The aim of this study was to evaluate survival and prognostic factors associated with a liberal exclusionary policy.


METHODS
This is an analysis of data collected prospectively on 57 HCC patients who underwent LDLT at our institution between April 1998 and January 2007.


RESULTS
Overall 3-year survival was 62%; this increased to 71% when 45-day mortality was excluded from the analysis. Age proved to be a predictor of survival irrespective of the 45-day mortality. In contrast, the Model for End stage Liver Disease (MELD) score predicted survival only when 45-day mortality was included in the analysis, while alpha fetoprotein (AFP) level predicted survival only when it was excluded. Significant cut-off values were patient age of over 60 years, MELD score above 22, and AFP level greater than 400 ng/ml. A scoring system was developed. Survival rate at 3 years--including 45-day mortality--was 72% for score =2 and 41% for score >2 (P = 0.0146). When 45-day mortality was excluded, the survival rate at 3 years was 90% for score =2 and 32% for score >2 (P = 0.00002).


CONCLUSIONS
Our results could further enhance current guidelines on age, MELD score, and AFP level for patients with HCC being evaluated to undergo LDLT.
Sotiropoulos
Georgios C
GC
Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany. Georgios.sotiropoulos@uni-essen.de
Lang
Hauke
H
Sgourakis
George
G
Nadalin
Silvio
S
Molmenti
Ernesto P
EP
Radtke
Arnold
A
Paul
Andreas
A
Beckebaum
Susanne
S
Saner
Fuat H
FH
Baba
Hideo A
HA
Gerken
Guido
G
Malagó
Massimo
M
Broelsch
Christoph E
CE
D000293:Adolescent; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011379:Prognosis; D016016:Proportional Hazards Models; D055815:Young Adult