Selection criteria of living donor liver transplantation for hepatocellular carcinoma developed in Korean transplant centers

Abstract

With accumulated experience on living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC), several major Korean transplant centers presented institutional or multicenter selection criteria of LDLT for HCC based on their own experience. This study intended to review the selection criteria of LDLT for HCC developed in the major Korean LT centers. Extended criteria for primary liver transplantation (LT) were developed in Asan Medical Center (AMC) in 2008, the Catholic University of Korea in 2012, Samsung Medical Center in 2014, National Cancer Center Korea in 2016, the model to predict tumor recurrence after LDLT (MoRAL) in three centers in 2016, A-P 200 criteria in Pusan National University in 2016, patient selection by tumor markers in LT for advanced HCC in eight centers, composite criteria using clinical and PET factors in two centers in 2019, tumor size and number, AFP, PIVKA-II, PET (SNAPP) score in AMC in 2021, and quantitative prognostic prediction using AFP-PIVKA-II-tumor volume (ADV) score in AMC in 2021. The criteria for salvage LT were developed from a multicenter study involving three centers in 2014 and from AMC in 2020. Posttransplant prognostic prediction models for early or non-viable HCC were developed in AMC for super-selection criteria in 2011 and pretransplant treatment-induced complete tumor necrosis in 2017. The importance of tumor biology in HCC treatment has been emphasized more than before. The expression of serum tumor markers is a surrogate biomarker reflecting the tumor biology. Pretransplant radiological assessment of HCC combined with tumor marker expression or PET finding will provide reliable information that will assist the decision to perform LDLT in patients with HCC of various stages.

Twenty-year longitudinal follow-up after liver transplantation: a single-center experience with 251 consecutive patients

“…Compared with the recent results of adult LDLT, the incidence of HCC recurrence-associated patient mortality was noticeably low, likely because the proportion of LDLT patients with HCC was correspondingly low [ 8 ]. The proportion of patients with HCC has been gradually increasing over time, and HCC has been one of the main indications for adult LDLT at our institution during the last 10 years.…”

“…Less is known, however, about actual 20-year survival data and immunosuppressive regimens in Korea [ 3 - 5 ]. There have been remarkable developments in LT in Korea during the last 20 years, including the introduction of many innovative surgical techniques, especially regarding living donor LT (LDLT), the more frequent performance of deceased donor LT (DDLT), and improvements in immunosuppressive regimens [ 6 - 9 ]. The present study retrospectively analyzed the clinical outcomes and immunosuppressive regimens of LT survivors who have been followed up for 20 years.…”

Technical refinement of inferior vena cava replacement using a synthetic vascular graft in living donor liver transplantation

“…The large-caliber synthetic vascular graft contains multiple vertical pleats which can be stretched, suggesting the need to avoid redundancy through application of adequate tension [6,7]. The indications of LDLT for HCC have been expanded beyond the Milan criteria [8][9][10][11]. A few reports revealed higher rates of posttransplant HCC recurrence following LDLT than DDLT [12,13].…”

Liver Transplantation for Hepatocellular Carcinoma: A Narrative Review and A Glimpse into The Future

“…LDLT not only decreased patient dropout rates from the WL but also expanded the use of LT as a treatment option for advanced HCC patients who typically lack surgical alternatives. Many Korean centers have developed their own selection criteria [124] (Table 1), with unique experiences handling "far advanced" HCC patients and those with macrovascular invasion. For instance, Seoul National University Hospital reported a 23.9% 2-year-disease-free survival rate among highly selected "far advanced" HCC patients (n=22, tumor size>10cm, >10 nodules, or with macrovascular invasion).…”