Korean J Transplant.  2022 Nov;36(Supple 1):S342. 10.4285/ATW2022.F-4878.

The impact of applying University of California San Francisco criteria to patients underwent liver transplantation for hepatocellular carcinoma in a low volume center

• Jung MY
• Kim D
• Lee DH
• Choi ST
• Park YH

• KMID: 2535569
• DOI: http://doi.org/10.4285/ATW2022.F-4878

Abstract

Background
There are many studies in patients with hepatocellular carcinoma applying the expanded Milan criteria. The University of California San Francisco (UCSF) criteria are considered as the most promising expansion rules so far. Based on UCSF criteria, we selected the patients underwent liver transplantation for hepatocellular carcinoma since 2008. Here we reported the long-term outcomes of patients underwent liver transplantation for hepatocellular carcinoma to assess the validity of the UCSF criteria instead of Milan in a single center.
Methods
Between 2008 and 2020, a total of 201 liver transplantation were performed, of which 39 were liver transplantation for hepatocellular carcinoma patients. Among them, living donor transplantations were 29 cases and deceased donor transplantations were 10 cases. Based on radiologic examination prior to operation, patients were prospectively categorized into two groups: within Milan (n=32) and beyond Milan within UCSF (n=7). Clinical outcomes were reviewed retrospectively.
Results
Mean age of patients was 51.2 years, and 28 patients were male. Mean model for end-stage liver disease (MELD) score was 11.2±8.7. Mean follow-up period was 63.7±54.6 months. The 5-year overall survival rates in within Milan and within UCSF groups were 84.4% and 74.7%, respectively (P<0.041). The 5-year disease-free survival rates in within Milan and within UCSF groups were 94.7% and 76.0%, respectively (P<0.001). Generally, 5-year disease-free survival rate in total patients was acceptable (n=39, 76.0%). However, seven expanded patients from Milan were revealed very poor long term both 5-year overall survival rate and disease-free survival rate (n=7, 26.8%, 0%, respectively).
Conclusions
The Milan criteria are still optimal in seeking for long term good results in patients with hepatocellular carcinoma. When the UCSF criteria are applied to hepatocellular carcinoma patients, the overall long-term results are acceptable; however, there is a higher risk of recurrence compared to the Milan criteria.