Living donor liver transplantation for hepatocellular carcinoma across Milan criteria

Abstract

INTRODUCTION: Liver transplantation is the best treatment option for patients with unresectable hepatocellular carcinoma (HCC) and liver cirrhosis. Although restrictive selection criteria using Milan criteria yielded excellent survival results, the outcome of LDLT under extended selection criteria for HCC remains controversial. AIM OF STUDY: To investigate the outcome of LDLT for HCC using extended selection criteria for HCC. MATERIAL AND METHODS: A total of 83 patients who underwent LDLT for HCC were retrospectively analyzed. Patients with extrahepatic metastases, major vascular tumor invasion and diffuse HCC were excluded. Recurrence-free survival results were analyzed. Significant prognostic factors were identified using univariate and multivariate analyses. RESULTS: Thirty-three patients (39.8%) had HCC with pathological features exceeding Milan criteria. The median follow-up period was 46 months (22–120 months). The short-term outcomes between two groups were comparable. The 1-year, 3-year and 5-year recurrence-free survival rates for patients within Milan criteria were 93%, 78% and 72%, whereas those for patients beyond Milan criteria were 90%, 70% and 60%. There was no statistically significant difference between two groups. Treatment before liver transplantation was the independent poor prognostic factor for recurrence-free survival.