scholarly journals Living donor liver transplantation for hepatocellular carcinoma beyond the Milan criteria: outcome of expanded criteria in tumor size

BMC Surgery ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hsin-Rou Liang ◽  
Chia-En Hsieh ◽  
Kuo-Hua Lin ◽  
Chih-Jan Ko ◽  
Yu-Ju Hung ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Living Donor ◽  
Milan Criteria ◽  
Tumor Diameter ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Living Donor Liver Transplant ◽  
Expanded Criteria ◽  
Donor Liver Transplant

Abstract Background The Milan criteria are the universal standard of liver transplantation for hepatocellular carcinoma (HCC). Numerous expanded criteria have shown outcomes as good as the Milan criteria. In Taiwan, living donor liver transplant (LDLT) accounts for the majority of transplantations due to organ shortages. Methods We retrospectively enrolled 155 patients who underwent LDLT for HCC from July 2005 to June 2017 and were followed up for at least 2 years. Patients beyond the Milan criteria (n = 78) were grouped as recurrent or nonrecurrent, and we established new expanded criteria based on these data. Results Patients beyond the Milan criteria with recurrence (n = 31) had a significantly larger maximal tumor diameter (4.13 ± 1.96 cm versus 6.10 ± 3.41 cm, p = 0.006) and total tumor diameter (7.19 ± 4.13 cm versus 10.21 ± 5.01 cm, p = 0.005). Therefore, we established expanded criteria involving maximal tumor diameter ≤ 6 cm and total tumor diameter < 10 cm. The 5-year survival rate of patients who met these criteria (n = 134) was 77.3%, and the 5-year recurrence rate was 20.5%; both showed no significant differences from those of the Milan criteria. Under the expanded criteria, the pool of eligible recipients was 35% larger than that of the Milan criteria. Conclusion Currently, patients with HCC who undergo LDLT can achieve good outcomes even when they are beyond the Milan criteria. Under the new expanded criteria, patients can achieve outcomes as good as those with the Milan criteria and more patients can benefit.

Living donor liver transplantation in hepatocellular carcinoma beyond the Milan criteria

2008 ◽  
Vol 28 (8) ◽  
pp. 1120-1128 ◽  
Author(s):  
Hyun Young Woo ◽  
Jeong Won Jang ◽  
Jong Young Choi ◽  
Chan Ran You ◽  
Soung Won Jeong ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Milan Criteria ◽  
Donor Liver ◽  
Donor Liver Transplantation

Pharyngeal metastasis following living-donor liver transplantation for hepatocellular carcinoma: case report and review of literature

2020 ◽  
Author(s):  
Taiji Tohyama ◽  
Katsunori Sakamoto ◽  
Kei Tamura ◽  
Taro Nakamura ◽  
Jota Watanabe ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Lymph Node ◽  
Lymph Node Dissection ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Milan Criteria ◽  
Node Dissection ◽  
Donor Liver ◽  
Donor Liver Transplantation

Abstract Background: The most common sites of recurrence after liver transplantation for hepatocellular carcinoma (HCC) have been reported to be the liver, lung, bone, and adrenal glands, but there have also been many reports of cases of multiple recurrence. The prognosis after recurrence is poor, with reported median survival after recurrence of HCC ranging from 9 to 19 months. Here, we report a case of long-term survival after recurrence of pharyngeal metastasis following living-donor liver transplantation (LDLT) for HCC within the Milan criteria, by resection of the metastatic region and cervical lymph node dissection. Case presentation: A 47-year-old man with a Model End-stage Liver Disease (MELD) score of 11 underwent LDLT for HCC within the Milan criteria for liver cirrhosis associated with hepatitis B virus infection, with his 48-year-old elder brother as the living donor. One year and 10 months after liver transplantation, he visited a nearby hospital with a chief complaint of discomfort on swallowing. A pedunculated polyp was found in the hypopharynx, and biopsy revealed HCC metastasis. We performed pharyngeal polypectomy. Two years later, cervical lymph nodes metastasis appeared, and neck lymph node dissection was performed. Although recurrence subsequently occurred three times in the grafted liver, the patient is still alive 12 years and 10 months after recurrence of pharyngeal metastasis. He is now a tumor-free outpatient taking sorafenib. Conclusion: It is necessary to recognize that the nasopharyngeal region is a potential site of HCC metastasis. Prognostic improvement can be expected with close follow-up, early detection, and multidisciplinary treatment, including radical resection.

Living Donor Liver Transplantation for Patients with HCC Exceeding the Milan Criteria: A Proposal of Expanded Criteria

2007 ◽  
Vol 25 (4) ◽  
pp. 299-302 ◽  
Author(s):  
Yasutsugu Takada ◽  
Takashi Ito ◽  
Mikiko Ueda ◽  
Seisuke Sakamoto ◽  
Hironori Haga ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Milan Criteria ◽  
Donor Liver ◽  
Donor Liver Transplantation ◽  
Expanded Criteria

scholarly journals Living Donor Liver Transplantation: The Optimal Curative Treatment for Hepatocellular Carcinoma Even Beyond Milan Criteria

2021 ◽  
Vol 28 ◽  
pp. 107327482110119
Author(s):  
Altan Alim ◽  
Yalcin Erdogan ◽  
Murat Dayangac ◽  
Yildiray Yuzer ◽  
Yaman Tokat ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Transplantation ◽  
Prognostic Factors ◽  
Vascular Invasion ◽  
Living Donor ◽  
Living Donor Liver Transplantation ◽  
Alpha Fetoprotein ◽  
Milan Criteria ◽  
Donor Liver ◽  
Donor Liver Transplantation

Introduction: Liver transplantation offers the most reasonable expectation for curative treatment for hepatocellular carcinoma. Living-donor liver transplantation represents a treatment option, even in patients with extended Milan criteria. This study aimed to evaluate the outcomes of hepatocellular carcinoma patients, particularly those extended Milan criteria. Materials and Patients: All HCC patients who received liver transplant for HCC were included in this retrospective study. Clinical characteristics including perioperative data and survival data (graft and patient) were extracted from records. Univariate and multivariate analyses was performed to identify significant prognostic factors for survival, postoperative complications and recurrence. Results: Two-hundred and two patients were included. The median age was 54.8 years (IQR 53-61). Fifty-one patients (25.3%) underwent deceased donors liver transplantation and 151 patients (74.7%) underwent living donor liver transplantation. Perioperative mortality rate was 5.9% (12 patients). Recurrent disease occurred in 43 patients (21.2%). The overall 1-year and 5-year survival rates were 90.7% and 75.6%, respectively. Significant differences between patients beyond Milan criteria compared to those within Milan criteria were not found. Alpha-fetoprotein level >300 ng/mL, vascular invasion, and bilobar tumor lesions were independent negative prognostic factors for survival. Conclusion: Liver transplantation is the preferred treatment for hepatocellular carcinoma and it has demonstrated an excellent potential to cure even in patients with beyond Milan criteria. This study shows that the Milan criteria alone are not sufficient to predict survival after transplantation. The independent parameters for survival prediction are Alpha-Fetoprotein-value and status of vascular invasion.

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