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Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation

  • Original Article
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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

A majority of patients with hepatocellular carcinoma (HCC) undergoing liver transplantation (LT) meet the Milan criteria, but these are still regarded as the narrowest criteria for transplantation. Prognostic analysis of incidentally detected HCC after LT suggests that a subgroup of HCC patients is at very low risk of recurrence. To determine the criteria defining this super-selection group, we retrospectively analyzed survival data of 593 adult living-donor LT recipients with HCC in the explanted liver

Discussion

Tumor features of incidental HCC in 38 patients not showing recurrence were analyzed. Of these patients, 34 (89.5%) each had ≤2 tumors and tumors ≤2.0 cm in size. Applying these criteria to 555 patients with pretransplant known HCC (pkHCC) allowed us to identify 79 patients with untreated pkHCCs ≤2.0 cm in size. To date, only two of these patients have shown recurrence, making the conditions for super-selection the presence of tumors ≤2.0 cm in size, ≤2 tumors, alpha-fetoprotein ≤200 ng/mL, and no pretransplant treatment. In 87 patients satisfying these criteria, the 10-year recurrence and survival rates were 1.3% and 92.1%, respectively. After excluding patients meeting these criteria, the 5-year recurrence rates in patients satisfying the Milan, University of California at San Francisco, and Asan criteria were increased by 2.9–4.0%. In conclusion, this super-selection or super-Milan category may be used for validation assessment of various indication criteria and for the development of cost-effective post-transplantation HCC surveillance protocols. Further studies should be followed for deceased-donor LT and patients who have undergone pretransplant treatment.

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Abbreviations

DDLT:

Deceased-donor liver transplantation

HCC:

Hepatocellular carcinoma

iHCC:

Incidentally found HCC

PkHCC:

Pretransplantation known HCC

LDLT:

Living-donor liver transplantation

LT:

Liver transplantation

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Acknowledgments

The authors would like to thank RNs. Hea-Seon Ha, Jeong-Ja Hong, In-Ok Kim, Mi-Kyeong Jeon, Ji-Seon Yun, Seon-Young Choi, Jeong-Eun Ma, and Yu-Jin Kang for their contributions toward data collection.

Funding

Specific funding was not used for this study.

Disclosure

All authors assert that there is no conflict of interest that could bias this work.

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Authors and Affiliations

  1. Department of Surgery, Division of Hepatobiliary Surgery and Liver Transplantation, Asan Medical Center, University of Ulsan College of Medicine, Seoul, 138-736, South Korea

    Shin Hwang, Chul-Soo Ahn, Ki-Hun Kim, Deok-Bog Moon, Tae-Yong Ha, Gi-Won Song, Dong-Hwan Jung, Gil-Chun Park, Young-Dong Yu, Pyoung-Jae Park, Young-Il Choi & Sung-Gyu Lee

  2. Department of Diagnostic Radiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Kyoung-Won Kim

  3. Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Young-Suk Lim & Han Chu Lee

  4. Department of Pathology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea

    Eun-Sil Yu

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  1. Shin Hwang
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  16. Sung-Gyu Lee
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Correspondence to Sung-Gyu Lee.

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Hwang, S., Ahn, CS., Kim, KH. et al. Super-selection of a Subgroup of Hepatocellular Carcinoma Patients at Minimal Risk of Recurrence for Liver Transplantation. J Gastrointest Surg 15, 971–981 (2011). https://doi.org/10.1007/s11605-011-1467-0

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  • DOI: https://doi.org/10.1007/s11605-011-1467-0

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