Korean J Transplant.  2023 Nov;37(Suppl 1):S314. 10.4285/ATW2023.F-9271.

Validation of novel Japanese 5-5-500 criteria in large Indian LDLT cohort: a retrospective study

• Verma S
• Das LK
• Ohira M
• Ohdan H
• Gupta S

• KMID: 2551943
• DOI: http://doi.org/10.4285/ATW2023.F-9271

Abstract

Background
Liver transplantation is a curative treatment for selected patients with hepatocellular carcinoma (HCC). However, recurrence may still happen in 20% to 30% of the transplanted recipient. The widely accepted Milan criteria are restrictive and may deny many patients who would otherwise have a chance for a cure. Also, Milans criteria do not include alpha-fetoprotein (AFP) values. Thus, the quest for a more inclusive criteria continues. The novel Japanese criteria is unique as it includes size, number, and AFP value, all of which impact long-term survival. Therefore, we aim to validate this criterion in our cohort.
Methods
We retrospectively enrolled 3,677 patients who underwent living donor liver transplants (LDLT) at our center from 2006–2022. After excluding we had 600 patients who underwent LDLT for HCC. We categorized into four groups, group 1 (Milan+, 5-5-500+; n=435), group 2 (Milan–, 5-5-500+; n=62); group 3 (Milan+, 5-5-500–; n=17); and group 4 (Milan–, 5-5-500–; n=86), respectively. Clinico-demographic data, rates of recurrence of HCC, and long-term survival after surgery were obtained from clinical records. Baseline characteristics, overall survival, recurrence-free survival, and risk factors for recurrence-free survival were analyzed.
Results
The rate of HCC recurrence was significantly higher in group 4 compared to groups 1, 2, and 3 (12.7% vs. 6.6%, 6.4%, and 5.8%). The overall 5-year survival and recurrence-free survival were significantly better in group 2 compared to other groups (log-rank; P=0.0004 and P=0.04) respectively. AFP>25, downstaging+, beyond Milan, and beyond 5-5-500 were significant independent risk factors for recurrence in the overall cohort. In addition, graft-to-recipient weight ratio <1 was significant risk factor for HCC recurrence in 5-5-500 cohort.
Conclusions
Thus, 5-5-500 criteria could increase the number of eligible LDLT candidates for transplant by 7.5% compared to Milan as in our cohort. This novel criteria may help us to expand HCC candidates with HCC who may have long-term better overall and recurrence-free survival.