Abstract
Background: In deceased donor liver transplantation (DDLT), transplant eligibility for T3–T4 HCC requires successful downstaging (DS). Living donor liver transplantation (LDLT) can be considered selectively in these patients without DS, but its role is not defined. The objective of the current study was to assess outcomes of LDLT for HCC based on UNOS staging with no prior DS.Materials and Methods: Patients who underwent LDLT for HCC (n = 262) were staged based on modified UNOS TNM staging. High-risk factors were identified and 5-year recurrence free survival was compared in patients with T2–T4 HCC.Results: Median follow-up was 30.2 (16.4–46.3) months. Recurrence rate in T1, T2, T3, T4a, and T4b HCC was 0, 10.1, 16.1, 5.9, and 37.5% (P = 0.02), respectively. On multivariate analysis, AFP > 600 ng/mL [HR:11.7, P < 0.001] and T4b HCC (macrovascular invasion) [HR = 5.6, P = 0.03] were predictors of recurrence. After exclusion of AFP > 600 ng/mL, 5-year RFS for T2, T3, and T4a HCC was 94, 86, and 92% (P = 0.3). Rate of microvascular invasion between T2 and T3 HCC was 24.3 vs. 53.6% (P = 0.005), and between T2 and T4a HCC was 24.3 vs. 36.7% (P = 0.2). Overall, 26 (19.4%) patients were overstaged and 23 (17.1%) were understaged on preoperative imaging. The 5-year RFS in patients with identical preoperative and histopathological staging was 94, 87, and 94% (P = 0.6).Conclusion: LDLT without prior DS leads to comparable survival for UNOS T2, T3, and T4a HCC as long as AFP is < 600 ng/mL.
Highlights
Liver transplantation (LT) is an established treatment modality for patients with liver cirrhosis and hepatocellular carcinoma (HCC) [1]
The objective of the current study was to assess outcomes of Living donor liver transplantation (LDLT) for HCC based on united network for organ sharing (UNOS) staging with no prior DS
LDLT without prior DS leads to comparable survival for UNOS T2, T3, and T4a HCC as long as alpha fetoprotein (AFP) is < 600 ng/mL
Summary
Liver transplantation (LT) is an established treatment modality for patients with liver cirrhosis and hepatocellular carcinoma (HCC) [1]. In patients with HCC, Milan criteria and University of California San Francisca criteria (UCSF) remain the benchmark for patient selection [2, 3]. These criteria are based on tumor-related features, including tumor size and number. In the United States, patients with united network for organ sharing (UNOS) T2 HCC (Milan criteria) are eligible for MELD exception points for LT. Patients with UNOS T3 HCC are granted exception points if Transplant for Advanced Liver Cancer successful downstaging (DS) to T2 HCC is demonstrated with locoregional therapy (LRT).
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
