Living Donor Liver Transplantation for Adult Patients With Hepatocellular Carcinoma

Abstract

LDLTx can achieve acceptable survival in HCC patients, even when liver function is markedly impaired, or HCC is uncontrollable by conventional antitumor treatments.

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

“…39,63,77 In agreement with the proven role of AFP as a prognostic tool (rather than a diagnostic tool) for HCC, high serum levels of AFP have been correlated with a deterioration in the prognosis of patients with tumors belonging to the MC category, even though a precise cutoff is missing (Table 3). Although the strength of the evidence is impoverished by the suboptimal quality (average NOS score ¼ 6) and the limited number of studies, 12,18,20,24,35,36,[38][39][40]51,54,65,80 AFP in clinical practice represents a quite reliable and noninvasive tool for capturing potentially more aggressive HCCs within the MC.…”

“…The meta-analysis included 19 studies 2,15,16,19,26,33,35,39,40,42,46,48,[53][54][55]57,63,67,84 that used different methodologies to compare the overall survival of patients meeting the MC and patients exceeding the criteria at the time of the explant pathology examination; 3949 patients were also stratified by the graft origin (deceased or living donors).…”

“…26,48 Similar rates of histological markers of tumor aggressiveness and poor prognoses have been detected in patients slightly exceeding the MC, such as patients meeting the University of California San Francisco criteria, 52,84 even though a significant proportion of patients meeting the University of California San Francisco criteria are meeting the MC as well. 24,34,47,51 We identified 10 studies 16,18,26,28,47,48,51,52,63,72 reporting frequency data for mVI and tumor grades in patients meeting or not meeting the MC, and a meta-analysis of the odds ratios was performed accordingly (Fig. 3).…”

Should we perform deceased donor liver transplantation after living donor liver transplantation has failed?

“…23 The survival rates are generally lower for patients exceeding the Milan criteria (1-year survival, 44% versus 56% 22 ; 3-year survival, 60% versus 79% 24 ), but they appear equal for those meeting the extended University of California San Francisco (UCSF) criteria and those meeting the Milan criteria (3-year survival, 90.6% versus 91.4%). 25 After LDLT, HCC recurrence rates at 3 years vary substantially (from 13% 24 to 55% 26 ).…”

New aspects of diagnosis and therapy of hepatocellular carcinoma

“…Various strategies have been examined, the most promising among them being live donation. Over 4000 living donor liver transplants using the right hepatic lobe have been performed worldwide, and early-to intermediate-term results from Asia (Kawasaki, 2002;Steinmuller et al, 2002;Gondolesi et al, 2004) and Japan (Todo and Furukawa, 2004) indicate that its performance is similar to cadaveric transplant and should be considered an option if the waiting time exceeds 7 months. However, there are some data suggesting that recurrence of HCV infection is more severe in patients receiving live donation (GarciaRetortillo et al, 2004), and this may force a reduction in the initial enthusiasm toward this treatment modality.…”