title: Living donor liver transplantation for hepatocellular carcinoma: the impact of neo-adjuvant treatments on the long term results.
abstract: OBJECTIVE
  LDLT may represent a valid therapeutic option allowing several advantages for patients affected by HCC and waiting for liver transplantation (LT). However, some reports show a worse long term survival and disease free survival among patients treated by LDLT for HCC than deceased donor liver transplantation (DDLT) recipients.
  
  
  METHODS
  Among 1145 LT patients, 63 received LDLT. From January 2000 to December 2008, 179 patients underwent LT due to HCC, 30 (16.7%) received LDLT and 154 (86.0%) received DDLT. Patients were selected based on the Milan criteria. TACE, radiofrequency ablation, percutaneous alcoholization, or liver resection were applied as downstaging procedures, while on the waiting list.
  
  
  RESULTS
  Overall 3- and 5-year survival rate was 77.3% and 68.7% vs. 82.8% and 76.7%, respectively for LDLT and DDLT recipient with not significant differences. Moreover, 3- and 5- years of recurrence free survival rate was 95.5% (LDLT) vs. 90.5% and 89.4% (DDLT) and resulted not significantly different.
  
  
  CONCLUSIONS
  LDLT guarantees same long term results than DDLT if the selection criteria of candidates are analogues. Milan criteria remains a valid candidate selection tool to obtain optimal long term results in LDLT. An aggressive downstaging policy seems to improve the long-term results in LDLT, thus LRT may be considered useful to prevent tumor progression waiting for transplantation as well as a neoadjuvant therapy for HCC. A literature detailed meta-analysis could definitely clarify if LDLT is an independent risk factor for HCC recurrence.
authors.affiliation: Department of General Surgery and Transplantation, Niguarda Ca'Granda Hospital, Milan, Italy. stefano.disandro@ospedaleniguarda.it
authors.forename: Stefano
authors.initials: S
authors.lastname: Di Sandro
authors.forename: Alessandro
authors.initials: A
authors.lastname: Giacomoni
authors.forename: Abdallah
authors.initials: A
authors.lastname: Slim
authors.forename: Andrea
authors.initials: A
authors.lastname: Lauterio
authors.forename: Iacopo
authors.initials: I
authors.lastname: Mangoni
authors.forename: Plamen
authors.initials: P
authors.lastname: Mihaylov
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Pirotta
authors.forename: Paolo
authors.initials: P
authors.lastname: Aseni
authors.forename: Luciano
authors.initials: L
authors.lastname: De Carlis
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D006498:Hepatectomy / Q000009:adverse effects / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D019520:Living Donors; D016015:Logistic Models; D008175:Lung Neoplasms / Q000401:mortality / Q000556:secondary; D020360:Neoadjuvant Therapy / Q000009:adverse effects / Q000401:mortality; D009364:Neoplasm Recurrence, Local / Q000401:mortality; D009367:Neoplasm Staging; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome; D014850:Waiting Lists / Q000401:mortality