Abstract:
Background. Liver transplantation is a widely accepted modality in the treatment of
hepatocellular carcinoma (HCC). In our center, patients with HCC limited to the liver
without macrovascular invasion are accepted as candidates for living donor liver transplantation
(LDLT). The aim of this study was to describe the patient characteristics and
outcomes at a single institution to analyze the impact of our criteria on the survival of HCC
patients.
Patients and Methods. We reviewed the medical records of all HCC (n 105) patients
who underwent liver transplantation in our institution. We excluded deaths in the early
postoperative period and deceased donor liver transplantation (DDLT) patients, leaving
74 subjects (65 males and 9 female). Their median age was 53 years (range, 19–69).
Univariate Kaplan-Meier and multivariate Cox proportional hazards models were used to
analyze overall and disease-free survivals.
Results. Thirty-two (43%) patients were within the Milan criteria, and 42 (57%)
exceeded them. One- and 2-year overall survival rates for patients within versus exceeding
the Milan criteria were 72% versus 68% and 61% versus 58%, respectively. One- and
2-year disease-free survival rates for patients within versus exceeding the Milan criteria
were 72% versus 68% and 60% versus 55%, respectively (P .05). Tumor recurrence rates
for patients within versus exceeding the Milan criteria were 0% versus 36%, respectively
(P .0002). Alpha-fetoprotein level was the only predictor of overall survival; alphafetoprotein
level and tumor differentiation were predictors of disease-free survival.
Conclusion. Although higher recurrence rates have been observed among patients
exceeding the Milan criteria, LDLT is the only treatment option for the patients in
countries with limited sources of cadaveric organs. As a general principle, we believe that
the use of cadaveric donor liver grafts is not suitable for patients who exceed these criteria.
