Comparative evaluation of expanded criteria for patients with hepatocellular carcinoma beyond the Milan criteria undergoing living‐related donor liver transplantation

Abstract

Compared with the other expanded criteria, the Kyushu University criteria may be useful to eliminate LT candidates at very high risk of HCC recurrence. The Kyushu University criteria were useful to evaluate LT candidates with HCC.

Relevance of microRNA‐18a and microRNA‐199a‐5p to hepatocellular carcinoma recurrence after living donor liver transplantation

“…However, the recurrence of HCC after LT is a critical problem to be solved because the outcomes of patients with HCC recurrence after LT are extremely poor. (6) Abbreviations: AFP, alpha-fetoprotein; DCP, des-gamma-carboxyprothrombin; DDLT, deceased donor liver transplantation; HBsAg, hepatitis B surface antigen; HCC, hepatocellular carcinoma; HCV, hepatitis C virus; HIF1A, hypoxia-inducible factor 1 alpha; IGF1R, insulin-like growth factor 1 receptor; IGF2, insulin-like growth factor 2; LDLT, living donor liver transplantation; LT, liver transplantation; M, recurrence-metastasis; miR-18a, microRNA-18a; miR-199a-5p, microRNA-199a-5p; miRNA, microRNA; mRNA, messenger RNA; miR-NC, microRNA inhibitor negative control; N, noncancerous liver; NF-jB, nuclear factor kappa B; NL, normal liver; nt, nucleotide; qRT-PCR, quantitative reverse transcriptionpolymerase chain reaction; T, primary hepatocellular carcinoma; TACE, transarterial chemoembolization; TNFAIP3, tumor necrosis factor alpha-induced protein 3; UTR, untranslated region; VEGFA, vascular endothelial growth factor A; vp, histopathological portal venous invasion; vv, histopathological venous invasion. …”

Selection of patients with hepatocellular carcinoma for liver transplantation: Past and future

“…Patients with 3-6 points are transplantable of tumors 1 2-3 4-5 > 5 or 6 Those with 7-12 points are not transplantable AFP (ng/mL) < 20 20-200 200.1-1.000 < 1.000 Akamatsu et al [68] Up to 5 nodules Upper limit for LDLT Maximum diameter ≤ 5 Kaido et al [69] Less that 10 nodules, all < 5 cm Upper limit for LDLT DCP < 400 mAu/mL Shirabe et al [70] n of nodules: No limit…”

“…Each center has developed and proposed expanded selection criteria based on institutional and regional experience, which vary from the model of Tokyo University [68] , which only considers morphological tumor parameters, i.e., up to 5 nodules with a maximum diameter ≤ 5 cm, without taking into account any biological markers. The Kyoto group [69] considers patients with less than 10 nodules, all less than 5 cm, with a DCP level < 400 mAU/mL, and the Kyushu group [70] also use extended criteria without limiting the number of nodules but require a maximum tumor diameter less than 5 cm and DCP levels under 300 mAU/mL.…”

Living Donor Liver Transplantation

“…Beyond this, there is poor survival, and it is not acceptable to expose the donor to the risks in this situation. Normally if a graft acutely fails, it requires an urgent retransplant (Shirabe K et al, 2011). If LDLT were used in a situation where a cadaveric 13 donor is contraindicated, such as exceeding the Milan Criteria, the urgent retransplant would require a cadaveric organ, even though the patient was originally contraindicated.…”

“…There is evidence to suggest, that Milan criteria may be too restrictive, and that there may be patients with potentially curable tumors that go untreated because of their exclusion from DDLT listing. The idea of using LDLT to transplant those patients with HCC exceeding the Milan Criteria requires a reasonable possibility of long-term survival (Shirabe K et al, 2011).…”