Post transplant survival in patients with hepatocellular carcinoma within and beyond Milan criteria

Abstract

Introduction: Living donor liver transplantation(LDLT) is an established treatment for patients with cirrhosis and hepatocellular carcinoma within Milan criteria. Acceptable outcomes have been demonstrated in patients fulfilling extended criteria. Here, we share our experience with LDLT for patients with HCC within and beyond Milan criteria with emphasis on poor prognostic factors. Methods: We retrospectively reviewed patients who underwent LDLT between 2012 and 2017 and had HCC proven on explant liver histopathology . A total of 117 patients were included. Patients who experienced early post transplant death (<30 days) were excluded. Demographics, patient and tumor characteristics were recorded. For outcomes, patients were divided into prognostic groups. These groups were based on 1) Poor differentiation 2) AFP > 600 and 3) presence of lympho vascular invasion. Recurrence free survival (RFS) was determined using Kaplan Meier curves. Results: Median age was 53(30–73) years. Median follow up was 20.3(1–63.2) months. Median MELD score was 19 (9–34). Out of total 117 patients, 74 (63.2%) patients fulfilled Milan criteria.Recurrence rate was 12/117 (10.3%). Actuarial 5 year RFS was 88% and 82%(P = 0.3) in patients within and outside Milan criteria. There was no difference in 3 year RFS in patients with 0, 1 or 2 poor prognostic factors within Milan criteria (92%, 87% and 75%)(P = 0.3). However, a significant difference in RFS was seen in patients outside Milan criteria (92%, 93% and 53%)(P = 0.03). Conclusion: Patients within Milan criteria have acceptable RFS even in presence of poor prognostic factors. However, presence of two or more poor prognostic variables significantly impacts RFS outside Milan criteria.