Prospective study on the outcome of patients with hepatocellular carcinoma registered for living donor liver transplantation: how long can they wait?
BACKGROUND.: In countries where cadaveric organ donation is limited, living donor liver transplantation (LDLT) has been reserved as a rescue option for the patients with uncontrollable hepatocellular carcinoma (HCC). PATIENTS AND METHODS.: Between March 2002 and June 2006, 56 patients with HCC had been registered as a LDLT candidate after HCC cannot be treated conventionally. We compared the survival rates between the patients who underwent LDLT (living donor liver transplantation group: LT, n=29) and those who did not undergo LDLT (no transplantation group: NLT, n=27). In the NLT group, we examined the periods suitable for resection or ablation (from first diagnosis to registration), suitable for LDLT, and unsuitable for LDLT. RESULTS.: Even among the patients who did not meet Milan criteria (LT: n=10, NLT: n=16), 1- and 3-year survival rates were significantly higher in the LT group than in the NLT group: 90.0% and 60.0% vs. 75.0% and 8.3%, respectively (P=0.046). In the NLT group, the median periods suitable for resection or ablation, suitable for LDLT, and unsuitable for LDLT were 28.9, 12.2, and 3.5 months, respectively. CONCLUSIONS.: LDLT is acceptable for the patients who gave up the conventional treatment. Approximately 12 months remain for the LDLT candidates with HCC to decide to undergo it.
Mizuno
Shugo
S
Department of Transplantation and Hepatobiliary Pancreatic Surgery, School of Medicine, Mie University, Tsu, Mie, Japan. mizunos@clin.medic.mie-u.ac.jp
Yokoi
Hajime
H
Shiraki
Katsuya
K
Usui
Masanobu
M
Sakurai
Hiroyuki
H
Tabata
Masami
M
Sugimoto
Kazushi
K
Takei
Yoshiyuki
Y
Yamakado
Koichiro
K
Takeda
Kan
K
Uemoto
Shinji
S
Isaji
Shuji
S
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D019520:Living Donors / Q000600:supply & distribution*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D011446:Prospective Studies; D012042:Registries; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists