Topics Liver transplantation for hepatocellular carcinoma around the world

Journal of Hepato-Biliary-Pancreatic Sciences

, Volume 17, Issue 5, pp 539-547

Liver transplantation for hepatocellular carcinoma: Korean experience

  • SungGyu LeeAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University Email author 
  • , ChulSoo AhnAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
  • , TaeYong HaAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
  • , DeokBog MoonAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
  • , KunMoo ChoiAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
  • , GiWon SongAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
  • , DongHwan ChungAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
  • , GilChun ParkAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
  • , YoungDong YuAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
    • , NamKyu ChoiAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
    • , KwanWoo KimAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
    • , KiHun KimAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University
    • , Shin HwangAffiliated withDepartment of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University

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Abstract

Hepatocellular carcinoma (HCC) is the second most common cause of male cancer death in Korea, where the major etiology, chronic hepatitis B virus infection, is endemic. With a high incidence of unresectable HCCs and a low cadaveric organ donation rate, the number of adult living-donor liver transplantations (LDLTs) has increased rapidly, by tenfold, over the past 10 years, as an alternative to deceased-donor liver transplantation (DDLT) in Asia, including Korea. Currently, HCC accounts for more than 40% of the indications for adult LDLT as the associated decompensation cirrhosis or unresectable HCC with 2.8% perioperative mortality at our institute. In determining eligibility for LDLT, the Milan criteria, which have a major aim of reducing the wastage of cadaveric liver grafts, still remain the gold standard. Our published results with 168 adult LDLTs show no difference from the results with DDLT for HCC that meets the Milan criteria. However, since a substantial proportion of adult LDLT patients not fulfilling the Milan criteria have been found to survive for longer than expected, and because a live donor organ is a private gift, most LDLT programs in Korea accept HCC patients beyond the Milan criteria, and the reported 3-year survival rates for such patients are approximately 63%. Our new proposal for expanded criteria (Asan criteria; tumor diameter ≤5 cm, number of lesions ≤6, no gross vascular invasion) in LDLT has focused on extending the number limits but keeping the maximum tumor size at 5 cm, because even modest expansion of tumor size limits beyond the Milan criteria adversely affected survival. The overall 5-year patient survival rates were 76.3 and only 18.9% within and beyond the Asan criteria, respectively; these criteria broaden the indications for patient selection and can more accurately identify patients who will benefit from LDLT than the conventional Milan criteria and the University of California at San Francisco criteria. In Asia, where the option for DDLT is minimal or negligible, LDLT with the modest expanded selection criteria will continue to provide a chance of long-term survival for some patients with advanced HCC.

Keywords

Hepatocellular carcinoma Living-donor liver transplantation Expanded selection criteria