The clinical outcomes of patients with portal vein tumor thrombi after living donor liver transplantation

Abstract

The purpose of this study was to evaluate the feasibility of living donor liver transplantation for treatment of patients with hepatocellular carcinoma and segmental portal vein tumor thrombus (PVTT) below the second-order branch. Between January 2005 and December 2015, we retrospectively analyzed 242 patients in a control group (n = 184), a microvascular invasion (MVI) group (n = 24), and a PVTT group (n = 34). To assess the risks associated with PVTT, we evaluated recurrence, the disease-free survival (DFS) rate, the overall survival (OS) rate, and various other factors based on the characteristics of patients and tumors. Of the 242 patients, 5-year DFS and OS rates were 79.5% and 70.7%. A total of 34 (14.0%) patients had PVTT, of whom 7 had lobar PVTT in first-order branches. The control, MVI, and PVTT groups significantly differed in terms of tumor morphology (maximal and total diameters) and biology (alpha-fetoprotein [AFP] and protein induced by vitamin K absence or antagonist II). The control, MVI, and PVTT groups significantly differed in terms of the recurrence, DFS, and OS rates. Especially, lobar PVTT reduced the 5-year DFS and OS rates to dismal and 14.3%, respectively, but segmental PVTT was associated with favorable 5-year DFS and OS rates (63.9% and 50.3%, respectively). We found no statistically significant difference in the DFS and OS rates of patients with MVI alone and segmental PVTT alone. In patients in the segmental PVTT group with AFP levels of <100 ng/mL, the 5-year DFS and OS rates were 90.9% and 71.3%, respectively. In conclusion, a tumor thrombus in a lobar portal vein remains a contraindication to liver transplantation. However, a segmental PVTT is acceptable, especially when the AFP level is <100 ng/mL. Liver Transplantation 23 1023-1031 2017 AASLD.

Graft Regeneration and Functional Recovery in Patients with Early Allograft Dysfunction After Living-Donor Liver Transplantation

“…The immunosuppression regimen consisted of 3 drugs, including a calcineurin inhibitor (tacrolimus or cyclosporine), mycophenolate mofetil (MMF), and steroid (prednisolone), in accordance with our hospital’s LDLT protocol [ 9 ]. The trough level of tacrolimus was maintained within 7 and 10 ng/mL for the first month after LDLT, and within 5 and 7 ng/mL thereafter.…”

The impact of serum cytokines in the development of early allograft dysfunction in living donor liver transplantation

“…[ 15 ] All of the patients who underwent LDLT were given immunosuppression such as tacrolimus, mycophenolate mofetil, prednisolone, and basiliximab based on the institutional immunosuppression schedule. [ 16 ]…”

Liver Transplantation for Hepatocellular Carcinoma. Working Group Report from the ILTS Transplant Oncology Consensus Conference

“…43 Therefore, UCSF criteria may be a more achievable downstaging endpoint before LDLT. Although some case series have reported successful downstaging of HCC with portal vein tumor thrombus often using Y-90 radio-embolization, [78][79][80][81] the small number of patients and limited follow up make it difficult to propose guidelines for LDLT in this population at present.…”