title: Evaluation of eligibility criteria in living donor liver transplantation for hepatocellular carcinoma by α-SMA-positive cancer-associated fibroblasts.
abstract: The eligibility criteria of liver transplantation (LT) for hepatocellular carcinoma (HCC) must clearly confirm the prognosis not only from pathological diagnosis but also from pre-operative imaging diagnosis. In the present study, we evaluated published eligibility criteria for LT based on both pre-operative imaging diagnosis and pathological diagnosis using living donor liver transplantation (LDLT) recipients at our hospital by α-smooth muscle actin (SMA)-positive cancer-associated fibroblasts (CAFs) in HCC. The Up-to-seven (Up-to-7), Asan and Tokyo criteria were evaluated, in both overall survival and HCC disease-free survival, to be statistically significantly beneficial criteria to define post-LDLT prognosis. Recipients only within Up-to-7 criteria based on both pre-operative imaging diagnosis and pathological diagnosis survived without HCC recurrence. Recipients with proliferation of α-SMA-positive CAFs in HCC had significantly poorer prognosis. All survival recipients without HCC recurrence, who were above the Up-to-7 criteria in pathological diagnosis, had no proliferation of α-SMA-positive CAFs. As a result of multivariate analysis, the significant independent factors defining prognosis of recipients after LDLT for HCC were Up-to-7 criteria and proliferation of α-SMA-positive CAFs. The ideal eligibility criteria for LDLT with HCC is Up-to-7 criteria and α-SMA-positive CAFs was considered to be an important factor in HCC recurrence. LDLT should be limited to recipients within Up-to-7 criteria or without proliferation of α-SMA-positive CAFs.
authors.affiliation: Department of Gastroenterologic Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan. takamuh@staff.kanazawa-u.ac.jp
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Takamura
authors.forename: Shinichi
authors.initials: S
authors.lastname: Nakanuma
authors.forename: Hironori
authors.initials: H
authors.lastname: Hayashi
authors.forename: Hidehiro
authors.initials: H
authors.lastname: Tajima
authors.forename: Kaheita
authors.initials: K
authors.lastname: Kakinoki
authors.forename: Seisyo
authors.initials: S
authors.lastname: Sakai
authors.forename: Isamu
authors.initials: I
authors.lastname: Makino
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Nakagawara
authors.forename: Tomoharu
authors.initials: T
authors.lastname: Miyashita
authors.forename: Koichi
authors.initials: K
authors.lastname: Okamoto
authors.forename: Keishi
authors.initials: K
authors.lastname: Nakamura
authors.forename: Katunobu
authors.initials: K
authors.lastname: Oyama
authors.forename: Masashi
authors.initials: M
authors.lastname: Inokuchi
authors.forename: Itasu
authors.initials: I
authors.lastname: Ninomiya
authors.forename: Hirohisa
authors.initials: H
authors.lastname: Kitagawa
authors.forename: Sachio
authors.initials: S
authors.lastname: Fushida
authors.forename: Takashi
authors.initials: T
authors.lastname: Fujimura
authors.forename: Ichiro
authors.initials: I
authors.lastname: Ohnishi
authors.forename: Masato
authors.initials: M
authors.lastname: Kayahara
authors.forename: Takashi
authors.initials: T
authors.lastname: Tani
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Arai
authors.forename: Taro
authors.initials: T
authors.lastname: Yamashita
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Yamashita
authors.forename: Hoshiko
authors.initials: H
authors.lastname: Kitamura
authors.forename: Hiroko
authors.initials: H
authors.lastname: Ikeda
authors.forename: Shuichi
authors.initials: S
authors.lastname: Kaneko
authors.forename: Yasuni
authors.initials: Y
authors.lastname: Nakanuma
authors.forename: Osamu
authors.initials: O
authors.lastname: Matsui
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Ohta
mesh_terms: D000199:Actins / Q000378:metabolism; D006528:Carcinoma, Hepatocellular / Q000378:metabolism / Q000601:surgery*; D018572:Disease-Free Survival; D004608:Eligibility Determination / Q000379:methods*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000378:metabolism / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery; D009367:Neoplasm Staging; D018579:Patient Selection; D011379:Prognosis; D016896:Treatment Outcome
chemical_list: C541116:ACTA2 protein, human; D000199:Actins