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Long-term outcomes of living donor liver transplantation after locoregional treatment for hepatocellular carcinoma: an experience from a single institute

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Abstract

Purpose

The precise role of downstaging or bridge therapy for cirrhotic patients with hepatocellular carcinoma (HCC) beyond or within the Milan criteria (MC) before living donor liver transplantation (LDLT) remains undefined.

Methods

We conducted a single-center, retrospective cohort study of 40 cirrhotic patients with HCC who underwent LDLT from 2000 to 2018. Dynamic computed tomography images at the initial presentation and immediately before LDLT as well as the final histopathological findings were reviewed to determine whether they met or exceeded MC.

Results

Overall, 29 patients underwent various pre-transplant HCC treatments, including ablation and embolization (bridge therapy, n = 20; downstaging, n = 9). Of the 9 patients who were initially beyond the MC, 4 (44.4%) were successfully downstaged to within the MC. Five patients beyond the MC immediately before LDLT demonstrated a significantly worse 5-year overall survival rate than patients within the MC (16.7% vs. 82.2%, P = 0.004), regardless of the radiological HCC stage at presentation or the final pathological tumor status. All 3 recurrent patients had HCC beyond the MC immediately before transplant and died of their disease at 13, 24, and 50 months after transplantation.

Conclusions

Successful downstaging for HCC cases beyond the MC provides similar outcomes to those within the MC at presentation, regardless of the histopathological findings.

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Author information

Authors and Affiliations

  1. Department of Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku, Tokyo, 160-8582, Japan

    Kenta Inomata, Hiroshi Yagi, Kentaro Matsubara, Yuta Abe, Minoru Kitago, Hideaki Obara & Yuko Kitagawa

  2. Department of Transplantation/Pediatric Surgery, Kumamoto University Graduate School of Medical Sciences, 2-39-1 Kurokami, Chuo-ku, Kumamoto, 860-8555, Japan

    Taizo Hibi

  3. Digestive Diseases Center, International University of Health and Welfare School of Medicine, 1-4-3 Mita, Minato-ku, Tokyo, 108-0073, Japan

    Masahiro Shinoda

  4. Department of Hepato-Biliary-Pancreatic and Gastrointestinal Surgery, International University of Health and Welfare School of Medicine, 4-3 Kozunomori, Narita, Chiba, 286-8686, Japan

    Osamu Itano

  5. Department of Gastrointestinal Surgery, Tokyo Medical University Hachiouji Medical Center, 1163 Tate-machi, Hachiouji, Tokyo, 193-0998, Japan

    Shigeyuki Kawachi

  6. Department of Hepato-Biliary-Pancreatic Surgery, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo, Tokyo, 113-8519, Japan

    Minoru Tanabe

  7. Department of Surgery, Ageo Central General Hospital, 1-10-10 Kashiwaza, Ageo, Saitama, 362-8588, Japan

    Go Wakabayashi

  8. Department of Gastrointestinal Surgery, Medical Corporation Koryukai Tamakyuryo Hospital, 1163 Shimooyamada-machi, Machida, Tokyo, 194-0202, Japan

    Motohide Shimazu

Authors
  1. Kenta Inomata
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  2. Hiroshi Yagi
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  3. Taizo Hibi
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  7. Minoru Kitago
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  14. Yuko Kitagawa
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Corresponding author

Correspondence to Hiroshi Yagi.

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Electronic supplementary material

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595_2020_2095_MOESM1_ESM.pdf

Supplementary file1 (PDF 187 kb) Supplementary Fig. S1 (Online Resource 1). The overall survival of patients with and without locoregional therapy before transplantation. The 5-year survival rates of patients with (n = 29) and without (n = 11) locoregional therapy were 68.0% and 72.7%, respectively. This difference was not statistically significant (P = 0.872).

595_2020_2095_MOESM2_ESM.pdf

Supplementary file2 (PDF 188 kb) Supplementary Fig. S2 (Online Resource 2). The overall survival of patients pathologically within and beyond Milan criteria. The 5-year survival rates of patients within (n = 18) and beyond (n = 22) Milan criteria were 83.3% and 65.7%, respectively. This difference was not statistically significant (P = 0.325).

595_2020_2095_MOESM3_ESM.pdf

Supplementary file3 (PDF 188 kb) Supplementary Fig. S3 (Online Resource 3). The overall survival of patients with and without vascular invasion. The survival rate of patients with vascular invasion (n = 17) was significantly lower than that of patients without invasion (n = 23; P = 0.020).

Supplementary file4 (PDF 118 kb)

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Inomata, K., Yagi, H., Hibi, T. et al. Long-term outcomes of living donor liver transplantation after locoregional treatment for hepatocellular carcinoma: an experience from a single institute. Surg Today 51, 350–357 (2021). https://doi.org/10.1007/s00595-020-02095-3

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  • DOI: https://doi.org/10.1007/s00595-020-02095-3

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