Role of Liver Transplantation for Hepatocellular Carcinoma

Kumaran, Vinay

doi:10.1016/j.jceh.2014.01.002

Cited by 19 publications

(18 citation statements)

References 35 publications

(34 reference statements)

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“…Although the Milan criteria are still recognized as the gold standard worldwide, it is generally agreed that the Milan criteria may be overly restrictive and thus exclude a significant number of HCC patients who could benefit from LT. Morphological parameters of tumors such as size and number may be the most significant predictors of HCC recurrence after LT, and have been used as a selection tool for LT candidates with HCC for 20 years since the extraordinary achievement of the Milan group. However, it is increasingly evident that these morphological parameters alone are not good enough to differentiate between tumors with favorable outcomes and those that disseminate early (5). Therefore, the expansion of the criteria using those morphological parameters seems to be at the breaking point.…”

Section: Expansion Of the Milan Criteriamentioning

confidence: 99%

“…In addition, it is not clear whether or not a physician has the right to deny a request for LDLT when a donor wishes to provide the only potential chance for curative treatment to his or her family member (5). Hence, many patients with advanced HCC undergo LDLT in Korea (31).…”

Section: How Far We Can Go In Ldlt For Hccmentioning

confidence: 99%

“…A living donor graft is dedicated to only one potential recipient, and is thus not allocated by the public organ sharing system (2,3). Therefore, a lower estimated survival rate after LT could be acceptable in LDLT compared with DDLT (4,5). Moreover, in Korea, LT for advanced HCC is not restricted by the Korean Network for Organ Sharing and is also not excluded by health insurance coverage.…”

Section: Introductionmentioning

confidence: 99%

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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: Expansion Of the Milan Criteriamentioning

confidence: 99%

Section: How Far We Can Go In Ldlt For Hccmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Advancements of liver transplantation for hepatocellular carcinoma in Korea

Lee

Suh

2016

Japanese Journal of Clinical Oncology

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“…The acceptable target outcome may vary from 50% to 60% survival at 5 years post-transplant to somewhere closer to that achieved when applying the Milan criteria (21). Maintaining an appropriate balance between recipient benefit and donor risk is crucial (22). Although a recent worldwide survey (18) reported that technical experience does not affect the incidence of living donor morbidity or mortality, major complication rates for living donors continue to be reduced by meticulous and innovative surgical techniques, increased experience-based expertise, and careful donor selection in high-volume LDLT centers (8).…”

Section: Limitation Of Tumor Status In Ldltmentioning

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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“…Due to the scarcity of organ availability for transplantation, strict criteria have been used to limit transplantation to patients with HCC who are likely to have good outcomes. Many argue that the MC is too restrictive and could potentially prevent some patients with favorable tumor biology to undergo LT (9). Many centers have used expanded criteria systems such as UCSF, Asian Medical Center, and the Toronto criteria to select patients for LT (9,10).…”

mentioning

confidence: 99%