Korean J Hepatobiliary Pancreat Surg.
2004 Dec;8(4):217-224.
Expansion of Indications for Liver Transplantation for the Patients with Hepatocellular Carcinoma
- Affiliations
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- 1Department of Surgery, Seoul National University College of Medicine, Seoul, Korea. kssuh@plaza.snu.ac.kr
Abstract
- PURPOSE
Liver transplantation (LT) offers the only chance to eliminate both tumor and the underlying liver disease for the patients with hepatocellular carcinoma (HCC). Although the Milan criteria was known as the standard selection criteria in cadaveric donor LT (CDLT), there are several reports that the criteria can be expanded without any significant increase of the tumor recurrence rate for living donor LT (LDLT). METHODS: 55 patients with HCC who were treated with LT from July 1997 to June 2003 were enrolled in our study. Hospital mortalities were excluded from the study and 46 patients were finally investigated. Their mean age was 51.2+/-7.0 years. LDLT was performed in 34 patients and CDLT was performed in 12 patients. RESULTS: The median follow-up duration was 16.3 months (range: 2.9~78.8 months). The overall 3-year survival rate was 75.1% and the disease-free survival rate was 77.6%. 34 patients met the Milan criteria; that is, a single nodule not more than 5 cm in size or three or fewer nodules not more than 3 cm in size. Their 3-year disease-free survival rate was 90.8%. 40 patients met the new expandable criteria that included patients with a single nodule not more than 6 cm in size, three or fewer nodules not more than 5 cm in size, and five or fewer nodules not more than 3 cm in size. Their 3-year disease-free survival rate was 89.7%, which was very similar to that of the patients who met the Milan criteria. CONCLUSION: In LDLT, we can expect that the Milan criteria can be expanded up to a single nodule not more than 6 cm in size, three or fewer nodules not more than 5 cm in size, and five or fewer nodules not more than 3 cm in size without further increasing the risk of recurrence.
