Expanded Criteria for Liver Transplantation in Patients with Hepatocellular Carcinoma

Kim, J.M.; Kwon, Choon Hyuck David; Joh, Jae‐Won; Park, J.B.; Lee, J.H.; Kim, G.S.; Kim, Seung Ju; Paik, Seung Woon; Lee, S.-K.

doi:10.1016/j.transproceed.2013.11.037

Cited by 43 publications

(42 citation statements)

References 14 publications

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“…Kim et al (35) at the Samsung Medical Center (SMC) used AFP to expand the selection criteria. They suggested that LDLT could reasonably be performed for HCC patients with no more than seven tumors 6 cm or less in diameter and with serum AFP levels of 1000 ng/ml or less (35). The 5-year recurrence-free rates were 84% within the Samsung criteria, which were similar to the original result (83% at 4 years after LT) of the Milan group (1,35).…”

Section: Expanded Korean Criteria For Lt For Hccmentioning

confidence: 56%

Advancements of liver transplantation for hepatocellular carcinoma in Korea

Lee

Suh

2016

Japanese Journal of Clinical Oncology

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The Milan criteria are still considered the gold standard for patient selection criteria for liver transplantation in patients with hepatocellular carcinoma. However, those criteria may be too strict and thus exclude a significant number of patients who could benefit from liver transplantation. Based on this notion, many expanded selection criteria have been suggested. In Asian countries, where there is a serious shortage of deceased donor organs, living donor liver transplantation accounts for the majority of all liver transplant cases. Because living donor liver transplantation is not controlled by the public allocation system, the indications for living donor liver transplantation can be expanded. In Korea, living donor liver transplantation depends entirely on the discretion of the transplant team and the donor. Hence, Korean transplant centers have had a reasonable amount of experience with liver transplantation for advanced hepatocellular carcinoma. Experiences in Korea show that serum alpha-fetoprotein level, des-gamma-carboxy prothrombin level and positron emission tomography are very useful biomarkers in predicting tumor recurrence after transplantation. Tumors that show favorable levels of these biomarkers might not recur after transplantation despite being morphologically advanced. In addition, combination therapy with mammalian target of rapamycin inhibitors and sorafenib may improve survival even after tumor recurrence. Therefore, in Korea, living donor liver transplantation is considered even for cases of far advanced hepatocellular carcinoma if a recipient has no other effective treatment options and a well-informed donor wishes to willingly participate.

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Section: Expanded Korean Criteria For Lt For Hccmentioning

confidence: 56%

Advancements of liver transplantation for hepatocellular carcinoma in Korea

Lee

Suh

2016

Japanese Journal of Clinical Oncology

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“…In the LDLT setting, the overall survival chance of the recipient as well as the preferences of the donor must be carefully considered. Most LDLT centers in Perspective on Liver Transplantation for Hepatocellular Carcinoma Indications for living donor liver transplantation in patients with hepatocellular carcinoma Asia now apply some expanded selection criteria for LDLT in patients with HCC (9)(10)(11)(12)(13)(14).…”

Section: Asian Perspective Of Ldlt For Hccmentioning

confidence: 99%

“…Some other centers in Asia have proposed further expansion of the criteria for LDLT in HCC using tumor markers (11)(12)(13)16). The Kyoto group (11) proposed newly expanded LDLT criteria, adding the serum des-gammacarboxy prothrombin (DCP) level to the selection criteria, while increasing the upper limit of the number of tumors to ten.…”

Section: Asian Perspective Of Ldlt For Hccmentioning

confidence: 99%

Indications for living donor liver transplantation in patients with hepatocellular carcinoma

Sugawara¹,

Inomata²

2016

Hepatobiliary Surg. Nutr.

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Liver transplantation is the optimal radical therapy for patients with cirrhosis and hepatocellular carcinoma (HCC). The Milan criteria are widely applied for deceased donor liver transplantation (DDLT) in the western countries. Living donor liver transplantation (LDLT), however, prevails in Asian countries due to the extreme shortage of deceased donor organs. In contrast to DDLT, the feasibility of LDLT is not restricted by the national allocation system, and therefore the indications for LDLT in patients with HCC depend on institutional policies that consider both the operative risk to the donor and the survival benefit for the recipient. The results of a nationwide survey as well as the experiences of individual centers demonstrate similar outcomes for patients whose tumors fall within the Milan criteria and those whose tumors extend beyond the Milan criteria.

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“…They reported that the 5-year overall and disease-free survival rates were 86.7 and 95.1% respectively in patients who met their new criteria [10]. Kim et al [59] of Korea defined the new expanded criteria as less than or equal to seven tumors, a maximum tumor size ≤6 cm, and serum AFP level ≤1000 ng/ml to minimize the risk of HCC recurrence. According to their analysis, the 5-year disease-free survival rate of patients within their new criteria was 90.0% [59].…”

Section: Prognostic Biologic Factors Of Lt For Hccmentioning

confidence: 99%

Liver Transplantation for Advanced Hepatocellular Carcinoma: How Far Can We Go?

Suh

Lee

2015

Hepat. Oncol.

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Liver transplantation is one of the most effective treatment options for hepatocellular carcinoma. Although the Milan criteria have been widely used to identify suitable candidates for liver transplant with a good prognosis, many transplant centers have developed and actually used more expanded criteria. Living donor liver transplant (LDLT) is at the center of expansion of criteria because it is based on the personal relationship between a recipient and a donor. Asian LDLT centers have developed various expanded criteria for LDLT using tumor biologic markers as well as the size and number of the tumors. However, there is no consensus on the limit of the expansion of criteria. Here, we present our experience and opinion on LDLT for advanced hepatocellular carcinoma.

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Expanded Criteria for Liver Transplantation in Patients with Hepatocellular Carcinoma

Cited by 43 publications

References 14 publications

Advancements of liver transplantation for hepatocellular carcinoma in Korea

Advancements of liver transplantation for hepatocellular carcinoma in Korea

Indications for living donor liver transplantation in patients with hepatocellular carcinoma

Liver Transplantation for Advanced Hepatocellular Carcinoma: How Far Can We Go?

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