Long-term survival analysis of living donor liver transplantation for hepatocellular carcinoma across Milan criteria

Abstract

BACKGROUND: Due to the shortage of deceased liver donor, living donor liver transplantation (LDLT) is the main viable option of transplantation for hepatocellular carcinoma (HCC) in the East. There is limited data in the literature on the long-term survival outcome of LDLT for HCC across Milan criteria. AIM OF STUDY: To investigate the long-term survival outcome of LDLT for HCC across Milan criteria in a single center PATIENTS 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 months – 120 months). The perioperative outcomes were comparable between patients with tumors within and outside Milan criteria. 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. Microvascular tumor invasion was the independent poor prognostic factor for recurrence-free survival, whereas liver tumor status beyond Milan criteria posed no influence on patients’ survival. CONCLUSION: LDLT for HCC exceeding Milan criteria is associated with acceptable overall and recurrence-free survival rates. More clinical prospective date is necessary to justify the expansion of selection criteria beyond Milan criteria of LDLT for HCC.