title: Liberal policy in living donor liver transplantation for hepatocellular carcinoma: lessons learned.
abstract: 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.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, 45122, Essen, Germany. Georgios.sotiropoulos@uni-essen.de
authors.forename: Georgios C
authors.initials: GC
authors.lastname: Sotiropoulos
authors.forename: Hauke
authors.initials: H
authors.lastname: Lang
authors.forename: George
authors.initials: G
authors.lastname: Sgourakis
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.forename: Ernesto P
authors.initials: EP
authors.lastname: Molmenti
authors.forename: Arnold
authors.initials: A
authors.lastname: Radtke
authors.forename: Andreas
authors.initials: A
authors.lastname: Paul
authors.forename: Susanne
authors.initials: S
authors.lastname: Beckebaum
authors.forename: Fuat H
authors.initials: FH
authors.lastname: Saner
authors.forename: Hideo A
authors.initials: HA
authors.lastname: Baba
authors.forename: Guido
authors.initials: G
authors.lastname: Gerken
authors.forename: Massimo
authors.initials: M
authors.lastname: Malagó
authors.forename: Christoph E
authors.initials: CE
authors.lastname: Broelsch
mesh_terms: 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