title: Outcome of Living-Donor Liver Transplant for Hepatocellular Carcinoma: 15-Year Single-Center Experience in Egypt.
abstract: OBJECTIVE
  Liver transplant performed for hepatocellular carcinoma must adhere to criteria for the size and number of focal hepatic lesions to lower the incidence of recurrence and achieve survival rates comparable to patients transplanted for other indications. Since the Milan criteria were established in 1996, there have been many less restrictive criteria yielding similar results. Our aim was to identify the prognostic factors for patient survival and for recurrence of hepatocellular carcinoma for patients within and beyond the Milan criteria.
  
  
  METHODS
  This retrospective and prospective analysis was conducted in 60 adult patients who underwent right lobe living-donor liver transplant for cirrhosis complicated by hepatocellular carcinoma at Dar Al Fouad Hospital, 6th of October City, Egypt, between August 2001 and June 2012. The median follow-up was 39.5 months.
  
  
  RESULTS
  Overall 1-, 3-, and 5-year survival rates were 98.3%, 93.5%, and 71.4%. Overall disease-free survival rates at 1, 3, and 5 years were 96.6%, 93.5%, and 64.2%. There was no statistically significant difference in overall survival time between patients within and beyond the Milan criteria. Factors affecting recurrence were the tumor grade, lobar distribution, size of the largest nodule, and the total tumor burden in the explanted liver. Recurrence adversely affected survival.
  
  
  CONCLUSIONS
  Using our criteria of a single tumor ≤ 6 cm, or 2 to 3 tumors with the largest ≤ 4.5 cm, or 4 to 5 tumors with the largest ≤ 3 cm and total tumor size ≤ 8 cm resulted in overall survival comparable to patients within the Milan criteria.
authors.affiliation: Department of Surgery, Ein Shams University, Cairo, Egypt.
authors.forename: Refaat
authors.initials: R
authors.lastname: Kamel
authors.forename: Yaser
authors.initials: Y
authors.lastname: Hatata
authors.forename: Karim
authors.initials: K
authors.lastname: Hosny
authors.forename: Ahmed
authors.initials: A
authors.lastname: Nabil
authors.forename: Alaa
authors.initials: A
authors.lastname: El-Deen Abd-Allah
authors.forename: Aaser
authors.initials: A
authors.lastname: Mostafa
authors.forename: Amr
authors.initials: A
authors.lastname: Abdel-Aal
authors.forename: Mahmoud Z
authors.initials: MZ
authors.lastname: Elganzoury
authors.forename: Osama
authors.initials: O
authors.lastname: Elmalt
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Marwan
authors.forename: Adel
authors.initials: A
authors.lastname: Hosny
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D004534:Egypt; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D007166:Immunosuppressive Agents