title: Living donor liver transplantation for hepatocellular carcinoma: a single center analysis of outcomes and impact of different selection criteria.
abstract: We examined the outcomes of patients who received living donor liver transplantation (LDLT) for HCC comparing the impact of up-to-seven criteria and Asan Criteria (AC) with Milan Criteria (MC). Between July 2004 and July 2009, of 175 consecutive LDLT, there were 45 consecutive patients with HCC. Forty patients who completed 12 months follow-up were enrolled. In search for the highest number of expansion, we selected AC as the extended criteria. Patients were divided into having tumors within MC, beyond MC within AC and Beyond Criteria (BC) groups. With a median follow-up of 46 months, overall 1, 3, and 5 years survival was -90%, -81%, and -70%, respectively. In patients within AC, estimated mean survival was 49.8 vs. 40.5 months for BC group (P = 0.2). Disease-free survival was significantly higher in patients within AC comparing with BC group; 48.0 vs. 38.6 months (P = 0.04). Preoperative AFP level >400 and poor tumor differentiation were factors adversely effecting recipient survival. On multivariate analysis, the presence of poor tumor differentiation (P = 0.018 RR: 2.48) was the only independent predictor of survival. Extension of tumor size and number to AC is feasible, without significantly compromising outcomes; however, the presence of poor tumor differentiation was associated with worse outcomes after LDLT.
authors.affiliation: Organ Transplantation Unit, Florence Nightingale Hospital, Istanbul, Turkey. dbalci@medicine.ankara.edu.tr
authors.forename: Deniz
authors.initials: D
authors.lastname: Balci
authors.forename: Murat
authors.initials: M
authors.lastname: Dayangac
authors.forename: Onur
authors.initials: O
authors.lastname: Yaprak
authors.forename: Baris
authors.initials: B
authors.lastname: Akin
authors.forename: Cihan
authors.initials: C
authors.lastname: Duran
authors.forename: Refik
authors.initials: R
authors.lastname: Killi
authors.forename: Yildiray
authors.initials: Y
authors.lastname: Yuzer
authors.forename: Yaman
authors.initials: Y
authors.lastname: Tokat
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D018579:Patient Selection; D016019:Survival Analysis