RF ablation and PMC thus far have had equivalent therapeutic effects, complication rates, and rates of residual foci of untreated disease. However, RF tumor ablation can be achieved with fewer sessions.

In the present study, the results of living donor liver transplantation (LDLT) for 125 hepatocellular carcinoma (HCC) patients were analyzed to determine optimal criteria exceeding the Milan criteria (MC) but still with predictably good outcomes. On the basis of pretransplant imaging studies, 70 patients met the MC, and 55 patients did not. Patients who exceeded the MC but presented with Յ10 tumors all Յ5 cm in diameter (n ϭ 30) displayed 5-year recurrence rates (7.3%) similar to those of patients within the MC (9.7%, P ϭ 0.8787). According to the results of multivariate analysis of risk factors for recurrence among preoperative tumor variables, we have defined the new criteria, namely Յ10 tumors all Յ5 cm in diameter and protein induced by vitamin K absence or antagonist-II (PIVKA-II) Յ400 mAU/mL. The 78 patients who met the new criteria showed significantly lower 5-year recurrence rates (4.9%) than the 40 patients who exceeded them (60.5%, P Ͻ 0.0001). Similarly, 5-year survival rates significantly differed between these groups (86.7% versus 34.4%, respectively; P Ͻ 0.0001). In conclusion, selection criteria for patients with HCC undergoing LDLT may be safely extended to Յ10 tumors all Յ5 cm in diameter and PIVKA-II Յ400 mAU/mL with acceptable outcomes. Liver Transpl 13: [1637][1638][1639][1640][1641][1642][1643][1644] 2007. © 2007 AASLD.Received April 3, 2007; accepted June 25, 2007. Orthotopic liver transplantation (OLT) has become widely accepted as the treatment of choice for early hepatocellular carcinoma (HCC). Among appropriately selected candidates, OLT for HCC provides excellent results, with overall survival rates exceeding 70%. [1][2][3] Mazzaferro et al. 1 reported that 48 patients with a single tumor Յ5 cm in diameter or with Յ3 tumors all Յ3 cm in diameter displayed survival rates comparable to those of non-HCC liver transplant recipients. These Milan criteria (MC) are currently widely accepted as an effective way of selecting patients with early-stage HCC for curative OLT.Conversely, because the MC were originally aimed at predicting good outcomes with low rates of recurrence, rather than poor outcomes with high recurrence rates, a substantial subset exists with the potential for good outcome after OLT among patients with HCC beyond the MC. In fact, many centers have performed OLT using extended criteria beyond the MC, showing acceptable overall and recurrence-free outcomes. [3][4][5][6][7][8][9] In particular, various rationales support the expansion of criteria for living donor liver transplantation (LDLT). First, in contrast to deceased donor liver transplantation (DDLT), which uses a scarce public resource subject to an equitable allocation system, living donor liver grafts are dedicated to related recipients. The acceptable recurrence rate is not absolute but rather depends on donor organ availability, and the value of LDLT for Abbreviations: AFP, ␣-fetoprotein; DDLT, deceased donor liver transplantation; GRWR, graft-to-recipient body weight ratio; HBV, hepatitis B virus; HCC, hepatocell...

L/S ratio calculated from preoperative CT can be a useful tool to discriminate hepatic macrovesicular steatosis. Based on the present results, the optimal cut-off value for L/S ratio to exclude more than moderate steatosis would be 1.1.

Percutaneous venoplasty is an effective treatment for hepatic venous outflow obstruction after LDLT.

Background: Optimal indications for living donor liver transplantation (LDLT) for patients with hepatocellular carcinoma (HCC) have yet not been established. The aim of the present study was to determine optimal criteria including categories outside the Milan criteria (MC) and still with a predictably good outcome. Patients and Methods: Between February 1999 and December 2007, 136 patients with HCC underwent LDLT. Based on preoperative imaging studies, 74 patients met the MC and 62 did not. Results: Overall patient survival rate at 5 years was 70%. Patients who exceeded MC but presented with ≤10 tumors and all ≤5 cm in diameter (n = 33) displayed similar 5-year recurrence rate to those within MC (7 vs. 10%). Based on the results of multivariate analysis of risk factors for recurrence, we defined new criteria as n ≤10 and all ≤5 cm and PIVKA-II ≤400 mAU/ml. The 5-year recurrence rate for the 83 patients who met the new criteria was significantly lower than for the 44 patients who exceeded them (5 vs. 61%, p < 0.0001). Similarly, patients who met the new criteria showed a significantly better 5-year survival rate (87 vs. 37%, p < 0.0001). Conclusion: The selection criteria may be safely extended up to n ≤10 and all ≤5 cm in diameter and PIVKA-II ≤400 mAU/ml with acceptable outcomes.