Living donor liver transplantation for Patients with beyond Milan hepatocellular carcinoma.
- Author:
Bong Wan KIM
1
;
Byong Ku BAE
;
Yong Keun PARK
;
Jae Hwan WON
;
Jae Ik BAE
;
Weiguang XU
;
Hee Jung WANG
;
Myung Wook KIM
Author Information
1. Department of Surgery, Ajou University School of Medicine, Suwon, Korea. wanghj@ajou.ac.kr
- Publication Type:Original Article
- Keywords:
Liver transplantation;
Living Donors;
Milan criteria;
HCC;
Hepatocellular carcinoma
- MeSH:
Biomarkers;
Biopsy, Needle;
Carcinoma, Hepatocellular;
Disease-Free Survival;
Follow-Up Studies;
Graft Rejection;
Hospital Mortality;
Humans;
Liver;
Liver Transplantation;
Living Donors;
Positron-Emission Tomography;
Prognosis;
Recurrence;
Retrospective Studies;
Stress, Psychological;
Survival Rate
- From:Korean Journal of Hepato-Biliary-Pancreatic Surgery
2008;12(3):162-167
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
BACKGROUND: To find the patients who have a significant chance of cure with living donor liver transplantation (LDLT) among the patients suffering with beyond-Milan hepatocellular carcinoma (HCC), we retrospectively analyzed the tumor factors that could affect a good prognosis after LDLT for patients who suffer with beyond Milan HCC. METHODS: Between March 2005 and May 2007, 18 cases of LDLT for beyond Milan HCC were performed. None of the patients had preoperative radiological evidence of vascular invasion. Excluding the 3 cases of in-hospital mortality, we analyzed the survival, the disease-free survival and the prognostic factors for recurrence in 15 beyond Milan HCC patients. The mean follow-up period was 18.8degrees +/- 8.8 months (range: 4-34 months). RESULTS: The two-year survival and disease-free survival rates after LDLT were 61.7% and 31.1%, respectively, in 15 beyond-Milan patients. Among them, 9 patients had recurrence of HCC during follow-up. The one-year survival rate after tumor recurrence was 55.5%. An alphafetoprotein (AFP) level < 400 ng/mL, Edmonson-Steiner histology grade I and II and the presence of graft rejection were analyzed as the good prognostic factors of disease-free survival after LDLT for beyond-Milan HCC (p < .05). The patients with negative preoperative positron emission tomography (PET) findings (n = 5) showed a better prognosis than the PET-positive patients (n = 10) with statistical significance (p = .05). CONCLUSION: Allowing that HCC patients exceed the Milan criteria, we can find the potentially curable candidates for LDLT with using tumor biologic markers such as a serum AFP level < 400 ng/mL, negative PET uptake or low grade histology, as assessed by preoperative needle biopsy. Further investigation is needed to evaluate the relation between graft rejection and tumor recurrence after liver transplantation.
