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Living Donor Liver Transplantation Outcomes for Hepatocellular Carcinoma Beyond Milan or UCSF Criteria

Indian Journal of Surgery volume 77, pages 950–956 (2015)Cite this article

Abstract

Liver transplantation (LT) is the most effective treatment for hepatocellular carcinoma (HCC) that arises from cirrhosis. The Milan and the University of California, San Francisco (UCSF) selection criteria have resulted in major improvements in patient survival. We assessed our outcomes for patients with HCC that were beyond the Milan and UCSF criteria after living donor liver transplantation. We reviewed the data for 109 patients with cirrhosis and HCC who underwent living donor right lobe liver transplantation (living donor liver transplantation; LDLT) during the period from July 2004 to July 2012. Sixteen (14.7 %) patients had HCC recurrences during a mean follow-up of 35.4 ± 26.2 months (range 4–100 months). The mean time to recurrence was 11 ± 9.4 months (range 4–26 months). Survival rates were not significantly different between patients with HCC that met and were beyond the Milan and UCSF criteria (p = 0.761 and p = 0.861, respectively). The Milan and UCSF criteria were not independent risk factors for HCC recurrence or patient survival. Only poorly differentiated tumors were associated with a lower survival rate (OR = 8.656, 95 % confidence interval (CI) 2.01–37.16; p = 0.004). Survival rates for patients with HCC that were beyond conventional selection criteria should encourage reconsidering the acceptable thresholds of these criteria so that more HCC patients may undergo LT without affecting outcomes.

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References

  1. Ferlay J, Shin HR, Bray F, Forman D, Mathers C, Parkin DM (2010) Estimates of worldwide burden of cancer in 2008. Int J Cancer 127:2893–2917

    CAS  Article  PubMed  Google Scholar 

  2. Cucchetti A, Cescon M, Trevisani F, Pinna AD (2012) Current concepts in hepatic resection for hepatocellular carcinoma in cirrhotic patients. World J Gastroenterol 18(44):6398–6408

    Article  PubMed  PubMed Central  Google Scholar 

  3. Zarrinpar A, Kaldas F, Busuttil RW (2011) Liver transplantation for hepatocellular carcinoma: an update. Hepatobiliary Pancreat Dis Int 10(3):234–242

    Article  PubMed  Google Scholar 

  4. Nissen NN, Menon V, Bresee C, Tran TT, Annamalai A, Poordad F et al (2011) Recurrent hepatocellular carcinoma after liver transplant: identifying the high-risk patient. HPB (Oxford) 13(9):626–632

    Article  Google Scholar 

  5. Bruix J, Sherman M (2005) Management of hepatocellular carcinoma. Hepatology 42:1208

    Article  PubMed  Google Scholar 

  6. Roayaie S, Schwartz JD, Sung MW, Emre SH, Miller CM, Gondolesi GE et al (2004) Recurrence of hepatocellular carcinoma after liver transplant: patterns and prognosis. Liver Transpl 10:534–540

    Article  PubMed  Google Scholar 

  7. Kim R, El-Gazzaz G, Tan A, Elson P, Byrne M, Chang YD et al (2010) Safety and feasibility of using sorafenib in recurrent hepatocellular carcinoma after orthotopic liver transplantation. Oncology 79:62

    CAS  Article  PubMed  Google Scholar 

  8. Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–699

    CAS  Article  PubMed  Google Scholar 

  9. Yao FY, Ferrell L, Bass NM, Watson CC, Bacchetti P, Venook A et al (2001) Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 33:1394–1403

    CAS  Article  PubMed  Google Scholar 

  10. Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A (1993) Liver resection versus transplantation. Surgery 218(2):145–151

    CAS  Google Scholar 

  11. Sarpel U, Schwartz M (2007) Liver transplantation for hepatocellular carcinoma. Hepatol Res 37(2):264–266

    Article  Google Scholar 

  12. Befeler AS, Hayashi PH, Di Bisceglie AM (2005) Liver transplantation for hepatocellular carcinoma. Gastroenterology 128:1752–1764

    Article  PubMed  Google Scholar 

  13. Ringe B, Pichlmayr R, Wittekind C, Tusch G (1991) Surgical treatment of hepatocellular carcinoma: experience with liver resection and transplantation in 198 patients. World J Surg 15:270–285

    CAS  Article  PubMed  Google Scholar 

  14. Iwatsuki S, Starzl TE, Sheahan DG, Yokoyama I, Demetris AJ, Todo S et al (1991) Hepatic resection versus transplantation for hepatocellular carcinoma. Ann Surg 214:221–228

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  15. Moreno P, Jaurrieta E, Figueras J, Benasco C, Rafecas A, Fabregat J et al (1995) Orthotopic liver transplantation: treatment of choice in cirrhotic patients with hepatocellular carcinoma? Transplant Proc 27:2296–2298

    CAS  PubMed  Google Scholar 

  16. Todo S, Furukawa H, Japanese Study Group on Organ Transplantation (2004) Living donor liver transplantation for adult patients with hepatocellular carcinoma: experience in Japan. Ann Surg 240:451–459

    Article  PubMed  PubMed Central  Google Scholar 

  17. Hwang S, Lee SG, Joh JW, Suh KS, Kim DG (2005) Liver transplantation for adult patients with hepatocellular carcinoma in Korea: comparison between cadaveric donor and living donor liver transplantations. Liver Transpl 11:1265–1272

    Article  PubMed  Google Scholar 

  18. Vakili K, Pomposelli JJ, Cheah YL, Akoad M, Lewis WD, Khettry U et al (2009) Living donor liver transplantation for hepatocellular carcinoma: increased recurrence but improved survival. Liver Transpl 15(12):1861–1866

    Article  PubMed  Google Scholar 

  19. Patel SS, Arrington AK, McKenzie S, Mailey B, Ding M, Lee W et al (2012) Milan criteria and UCSF criteria: a preliminary comparative study of liver transplantation outcomes in the United States. Int J Hepatol 2012:253517–253524

    PubMed  PubMed Central  Google Scholar 

  20. Duffy JP, Vardanian A, Benjamin E, Watson M, Farmer DG, Ghobrial RM et al (2007) Liver transplantation criteria for hepatocellular carcinoma should be expanded: a 22-year experience with 467 patients at UCLA. Ann Surg 246(3):502–509

    Article  PubMed  PubMed Central  Google Scholar 

  21. Lo CM, Fan ST, Liu CL, Chan SC, Ng OL, Wong J (2007) Living donor versus deceased donor liver transplantation for early irresectable hepatocellular carcinoma. Br J Surg 94:78–86

    CAS  Article  PubMed  Google Scholar 

  22. Fisher RA, Kulik LM, Freise CE, Lok AS, Shearon TH, Brown RS Jr, A2ALL Study Group et al (2007) Hepatocellular carcinoma recurrence and death following living and deceased donor liver transplantation. Am J Transplant 7:1601–1608

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  23. Onaca N, Davis GL, Goldstein RM, Jennings LW, Klintmalm GB (2007) Expanded criteria for liver transplantation in patients with hepatocellular carcinoma: a report from the International Registry of Hepatic Tumors in Liver Transplantation. Liver Transpl 13:391–399

    Article  PubMed  Google Scholar 

  24. Yao FY, Ferrell L, Bass NM, Bacchetti P, Ascher NL, Roberts JP (2002) Liver transplantation for hepatocellular carcinoma: comparison of the proposed UCSF criteria with the Milan criteria and the Pittsburgh modified TNM criteria. Liver Transpl 8:765–774

    Article  PubMed  Google Scholar 

  25. Sotiropoulos GC, Molmenti EP, Omar OS, Bockhorn M, Brokalaki EI, Lang H et al (2006) Liver transplantation for hepatocellular carcinoma in patients beyond the Milan but within the UCSF criteria. Eur J Med Res 11:467–470

    PubMed  Google Scholar 

  26. Lee SG, Hwang S, Moon DB, Ahn CS, Kim KH, Sung KB et al (2008) Expanded indication criteria of living donor liver transplantation for hepatocellular carcinoma at one large-volume center. Liver Transpl 14(7):935–945

    Article  PubMed  Google Scholar 

  27. Kakodkar R1, Soin AS (2012) Liver transplantation for HCC: a review. Indian J Surg 74(1):100–117

    Article  PubMed  PubMed Central  Google Scholar 

  28. Zheng Z, Liang W, Milgrom DP, Zheng Z, Schroder PM, Kong NS, Yang C, Guo Z, He X (2014) Liver transplantation versus liver resection in the treatment of hepatocellular carcinoma: a meta-analysis of observational studies. Transplantation 97(2):227–234

    Article  PubMed  Google Scholar 

  29. Berry K, Ioannou GN (2012) Are patients with Child’s A cirrhosis and hepatocellular carcinoma appropriate candidates for liver transplantation? Am J Transplant 12(3):706–717

    CAS  Article  PubMed  Google Scholar 

  30. Dhir M, Lyden ER, Smith LM, Are C (2012) Comparison of outcomes of transplantation and resection in patients with early hepatocellular carcinoma: a meta-analysis. HPB (Oxford) 14(9):635–645

    Article  Google Scholar 

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Affiliations

  1. Liver Transplantation Center, Florence Nightingale Hospital, Abidei Hurriyet Cad. No: 164 Sisli, 34679, Istanbul, Turkey

    Yusuf Gunay, Necdet Guler, Onur Yaprak, Murat Dayangac, Murat Akyildiz, Gulum Altaca, Yildiray Yuzer & Yaman Tokat

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  1. Yusuf Gunay
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  2. Necdet Guler
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  3. Onur Yaprak
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  7. Yildiray Yuzer
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Correspondence to Yusuf Gunay.

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Gunay, Y., Guler, N., Yaprak, O. et al. Living Donor Liver Transplantation Outcomes for Hepatocellular Carcinoma Beyond Milan or UCSF Criteria. Indian J Surg 77, 950–956 (2015). https://doi.org/10.1007/s12262-014-1078-6

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  • DOI: https://doi.org/10.1007/s12262-014-1078-6

Keywords

  • Living donor liver transplantation
  • The Milan criteria
  • UCSF criteria
  • Hepatocellular carcinoma