title: Liver transplantation for hepatocellular carcinoma: defining the impact of using extended criteria liver allografts.
abstract: BACKGROUND
  This series compares outcomes of patients with hepatocellular carcinoma (HCC) listed for orthotopic liver transplantation (OLT) within and outside Milan criteria, and determines the impact of extended criteria liver allografts (ECD).
  
  
  METHODS
  Records of patients listed for liver transplantation at a single center from 1998 to 2007 were reviewed retrospectively.
  
  
  RESULTS
  Ninety-seven HCC patients were listed for OLT, 77 underwent transplantation; 47 received ECDs and 30 standard organs. ECDs were more frequently allocated to outside Milan recipients. Wait time for OLT was shorter for outside Milan patients (4 vs. 7 months P=0.04) but hazard rate of dropout was higher (26%, 46%, and 73% at 6,12, and 24 months compared with 2%, 14%, and 60% P<0.01). Tumor size more than 3 cm (P=0.02) and model for end-stage liver disease score at listing more than 11 (P=0.04) were independent predictors of dropout. Hazard rate of OLT was similar within and outside Milan (61%, 80%, and 90% at 6, 12, and 24 months vs. 60%, 70%, and 86% P=0.38). Post-OLT survival at 1 year and 4 years were 88% and 63% within Milan compared with 79% and 62% among Milan out recipients (P=0.95). No significant post-OLT survival predictor was found.
  
  
  CONCLUSIONS
  The use of ECD organs provided patients with HCCs outside Milan criteria access to liver transplant at a rate comparable to patients within Milan and model for end-stage liver disease HCC priority. Similar patient survival post-OLT can be achieved using standard or ECD organs. The higher risk of drop out in patients outside Milan, and even within Milan, with tumors more than 3 cm justifies the use of ECD organs for timely transplantation.
authors.affiliation: Division of Liver Transplantation, Recanati/Miller Transplantation Institute, Mount Sinai Medical Center, New York, NY 10029, USA. marcelo.facciuto@mountsinai.org
authors.forename: Marcelo E
authors.initials: ME
authors.lastname: Facciuto
authors.forename: Manoj K
authors.initials: MK
authors.lastname: Singh
authors.forename: Umadevi
authors.initials: U
authors.lastname: Katta
authors.forename: Susana
authors.initials: S
authors.lastname: Samaniego
authors.forename: Jyoti
authors.initials: J
authors.lastname: Sharma
authors.forename: Manuel
authors.initials: M
authors.lastname: Rodriguez-Davalos
authors.forename: Patricia
authors.initials: P
authors.lastname: Sheiner
authors.forename: Leona
authors.initials: L
authors.lastname: Kim-Schluger
authors.forename: David C
authors.initials: DC
authors.lastname: Wolf
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D046148:Donor Selection; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D017751:Safety Management; D013997:Time Factors; D014019:Tissue Donors; D016896:Treatment Outcome; D014850:Waiting Lists