Living Donor Liver Transplantation for Malignant Hepatic Tumors

Abstract

A program of living donor liver transplantation was in operation for patients with malignant hepatic tumors. Since then there have been many controversies concerning indications based on tumor stage, the immunosuppressive regimens, postoperative chemotherapy, and preoperative ablation treatment. Between February 1999 and January 2001 a series of 30 patients with hepatocellular carcinoma received living donor liver transplants. The criteria for inclusion in this group were no evidence of extrahepatic tumor and no evidence of macroscopic tumor involvement in the portal or hepatic veins. The number or size of the tumor(s) was not taken into consideration. The patients consisted of 22 males and 8 females with a mean age of 49 years (range 12–68 years). The underlying liver diseases were hepatitis C (n = 12), hepatitis B (n = 11), hepatitis C and B (n = 2), alcoholism (n = 1), citrullinemia (n = 1), and unknown (n = 3). There was 1 patient in stage I, 3 in stage II, 3 in stage III, and 22 in stage IVA, as determined by preoperative imaging examinations. Immunosuppression consisted of tacrolimus monotherapy. To assess tumor recurrence, the α-feto protein and protein induced by vitamin K absence or antagonism (PIVKA-II) levels were checked monthly; and CT scans (abdomen, chest, brain) and bone scimtigraphy were undertaken every 3 months. Eight recipients died of sepsis (n = 3), peritonitis (n = 2), pneumonia (n = 1), cereberal bleeding (n = 1), and asphyxia (n = 1).