title: Adoption of new selection criteria on living donor liver transplantation for hepatocellular carcinoma and their impact on the outcome.
abstract: OBJECTIVE
  In cadaveric liver transplantation, the Milan criteria have been accepted as the selection criteria for HCC in considering organ allocation. However, the situation in LDLT is different.
  
  
  METHODS
  This is a retrospective study on 518 recipients who underwent LDLT. The exclusion criteria included HCC with extrahepatic spread and HCC extending to the major hepatic vessels detected during the preoperative evaluation.
  
  
  RESULTS
  HCC was the indication in 96 patients (18.5%); 52/96 patients (54.2%) fulfilled Milan criteria and 44/96 patients (45.8%) did not. The 5-year survival rate among patients fulfilling Milan criteria was 40/52 (77.0%) while for those who did not 30/44 (68.0%). Although these results show better survival rates among patients with HCC within the Milan criteria, they are insignificant (p=0.01) and they clearly demonstrate that patients with HCC outside the Milan criteria have nearly the same survival rate as patients with HCC within Milan criteria.
  
  
  CONCLUSIONS
  Transplantation is the best treatment option for patients with HCC if a careful search reveals no extra-hepatic disease. The application of the Milan criteria for all patients with HCC would have denied many patients who can survive after transplantation. In LDLT programs, where the patient has a special living donor, the Milan criteria are not necessarily relevant.
authors.affiliation: Department of General Surgery, Alexandria University, Alexandria, Egypt. aazzam70@yahoo.com
authors.forename: Ayman Z
authors.initials: AZ
authors.lastname: Azzam
authors.forename: Koichi
authors.initials: K
authors.lastname: Tanaka
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome