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Liver transplantation for hepatocellular carcinoma: Korean experience

  • Topics
  • Liver transplantation for hepatocellular carcinoma around the world
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Journal of Hepato-Biliary-Pancreatic Sciences

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.

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References

  1. de Villa V, Lo CM. Liver transplantation for hepatocellular carcinoma in Asia. Oncologist. 2007;12:1321–31.

    Article  PubMed  Google Scholar 

  2. Park JW, Kim CM. Epidemiology of hepatocellular carcinoma in Korea (in Korean). Korean J Hepatol. 2005;4:303–10.

    Google Scholar 

  3. Mazzaferro V, Regalia E, Doci R, et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med. 1996;334:693–9.

    Article  CAS  PubMed  Google Scholar 

  4. Kaihara S, Kiuchi T, Ueda M, et al. Living-donor liver transplantation for hepatocellular carcinoma. Transplantation. 2003;75:S37–40.

    Article  PubMed  Google Scholar 

  5. Shimada M, Fujii M, Morine Y, et al. Living-donor liver transplantation: present status and future perspective. J Med Invest. 2005;52:22–32.

    Article  PubMed  Google Scholar 

  6. Gondolesi GE, Roayaie S, Munoz L, et al. Adult living donor liver transplantation for patients with hepatocellular carcinoma: extending UNOS priority criteria. Ann Surg. 2004;239:142–9.

    Article  PubMed  Google Scholar 

  7. Sugawara Y, Tamura S, Makuuchi M. Living donor liver transplantation for hepatocellular carcinoma: Tokyo University series. Dig Dis. 2007;25:310–2.

    Article  PubMed  Google Scholar 

  8. Ito T, Takada Y, Ueda M, et al. Expansion of selection criteria for patients with hepatocellular carcinoma in living donor liver transplantation. Liver Transpl. 2007;13:1637–44.

    Article  PubMed  Google Scholar 

  9. Lee SG, Hwang S, Moon DB, Ahn CS, Kim KH, Sung KB, et al. Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transpl. 2008;14:935–45.

    Article  PubMed  Google Scholar 

  10. Fisher RA, Kulik LM, Freise CE, Lok AS, Shearon TH, Brown RS, et al. Hepatocellular carcinoma recurrence and death following living and deceased donor liver transplantation. Am J Transplant. 2007;7:1601–8.

    Article  CAS  PubMed  Google Scholar 

  11. Bigourdan JM, Jaeck D, Meyer N, et al. Small hepatocellular carcinoma in Child A cirrhotic patients: hepatic resection versus transplantation. Liver Transpl. 2003;9:513–20.

    Article  PubMed  Google Scholar 

  12. Margarit C, Escartin A, Castells L, et al. Resection for hepatocellular carcinoma is a good option in Child-Turcotte-Pugh class A patients with cirrhosis who are eligible for liver transplantation. Liver Transpl. 2005;11:1242–51.

    Article  PubMed  Google Scholar 

  13. Hwang S, Lee SG, Lee YJ, et al. Lessons learned from 1,000 living donor liver transplantations in a single center: how to make living donations safe. Liver Transpl. 2006;12:920–7.

    Article  PubMed  Google Scholar 

  14. Lo CM, Fan ST, Liu CL, Chan SC, Wong J. The role and limitation of living donor liver transplantation for hepatocellular carcinoma. Liver Transpl. 2004;10:440–7.

    Article  PubMed  Google Scholar 

  15. Lo CM, Fan ST, Liu CL, et al. Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma. Br J Surg. 2007;94:78–86.

    Article  CAS  PubMed  Google Scholar 

  16. Todo S, Furukawa H, the Japanese Study Group on Organ Transplantation. Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in Japan. Ann Surg. 2004;240:451–9.

    Article  PubMed  Google Scholar 

  17. Hwang S, Lee SG, Joh JW, et al. Liver transplantation for adult patients with hepatocellular carcinoma in Korea: comparison between cadaveric donor and living donor liver transplantations. Liver Transpl. 2005;11:1265–72.

    Article  PubMed  Google Scholar 

  18. Yao FY. Liver transplantation for hepatocellular carcinoma: beyond the Milan criteria. Am J Transplant. 2008;8:1982–9.

    Article  CAS  PubMed  Google Scholar 

  19. Weber M, Clavien PA. Hepatocellular carcinoma and liver transplantation: entering the area after the Milan and University of California at San Francisco criteria? Liver Transpl. 2008;14:911–4.

    Article  PubMed  Google Scholar 

  20. Yao FY, Xiao L, Bass NM, et al. Liver transplantation for hepatocellular carcinoma: validation of the UCSF-expanded criteria based on preoperative imaging. Am J Transplant. 2007;7:2587–96.

    Article  CAS  PubMed  Google Scholar 

  21. Onaca N, Davis GL, Goldstein RM, Jennings LW, Klintmalm GB. Expanded criteria for liver transplantation in patients with hepatocellular carcinoma: a report from the International Registry of Hepatic Tumors in Liver Transplantation. Liver Transpl. 2007;13:391–9.

    Article  PubMed  Google Scholar 

  22. Ravaioli M, Grazi GL, Piscaglia F, Trevisani F, Cescon M, Ercolani G, et al. Liver transplantation for hepatocellular carcinoma: results of down-staging in patients initially outside the Milan selection criteria. Am J Transplant. 2008;8:2547–57.

    Article  CAS  PubMed  Google Scholar 

  23. Iwatsuki S, Starzl TE, Sheahan DG, Yokoyama I, Demetris AJ, Todo S, et al. Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg. 1991;214:221–8.

    Article  CAS  PubMed  Google Scholar 

  24. Klintmalm GB. Liver transplantation for hepatocellular carcinoma: a registry report of the impact of tumor characteristics on outcome. Ann Surg. 1998;228:479–90.

    Article  CAS  PubMed  Google Scholar 

  25. Soejima Y, Taketomi A, Yoshizumi T, Uchiyama H, Aishima S, Terashi T. Extended indication for living donor liver transplantation in patients with hepatocellular carcinoma. Transplantation. 2007;83:893–9.

    Article  PubMed  Google Scholar 

  26. Hwang S, Lee SG, Ahn CS, Kim KH, Moon DB, Ha TY, et al. Small-sized liver graft does not increase the risk of hepatocellular carcinoma recurrence after living donor liver transplantation. Transplant Proc. 2007;39:1526–9.

    Article  CAS  PubMed  Google Scholar 

  27. Yang SH, Suh KS, Lee HW, Cho EH, Cho JY, Cho YB, et al. The role of 18F-FDG-PET imaging for the selection of liver transplantation candidates among hepatocellular carcinoma patients. Liver Transpl. 2006;12:1655–60.

    Article  PubMed  Google Scholar 

  28. Hatano E, Ikai I, Higashi T, Teramukai S, Torzuka T, Saga T, et al. Preoperative positron emission tomography with fluorine-18-fluorodeoxyglucose is predictive of prognosis in patients with hepatocellular carcinoma after resection. World J Surg. 2006;30:1736–41.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Hepato-Biliary Surgery and Liver Transplantation, Asan Medical Center, Ulsan University, PoongNap-Dong 388-1, SongPa-Ku, Seoul, 138-736, Korea

    SungGyu Lee, ChulSoo Ahn, TaeYong Ha, DeokBog Moon, KunMoo Choi, GiWon Song, DongHwan Chung, GilChun Park, YoungDong Yu, NamKyu Choi, KwanWoo Kim, KiHun Kim & Shin Hwang

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  1. SungGyu Lee
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  2. ChulSoo Ahn
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  12. KiHun Kim
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  13. Shin Hwang
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Correspondence to SungGyu Lee.

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Lee, S., Ahn, C., Ha, T. et al. Liver transplantation for hepatocellular carcinoma: Korean experience. J Hepatobiliary Pancreat Sci 17, 539–547 (2010). https://doi.org/10.1007/s00534-009-0167-6

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  • DOI: https://doi.org/10.1007/s00534-009-0167-6

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