Abstract
AimThe selection criteria for patients with hepatocellular carcinoma (HCC) to undergo liver transplantation should accurately predict posttransplant recurrence while not denying potential beneficiaries. In the present study, we attempted to identify risk factors associated with posttransplant recurrence and to expand the selection criteria.Patients and MethodsAdult patients with HCC who underwent liver transplantation between November 2004 and September 2012 at our centre were recruited into the current study (N = 241). Clinical and pathological data were retrospectively reviewed. Patients who died during the perioperative period or died of non-recurrence causes were excluded from this study (N = 25). All potential risk factors were analysed using uni- and multi-variate analyses.ResultsSixty-one recipients of 216 qualified patients suffered from recurrence. Similar recurrence-free and long-term survival rates were observed between living donor liver transplant recipients (N = 60) and deceased donor liver transplant recipients (N = 156). Total tumour volume (TTV) and preoperative percentage of lymphocytes (L%) were two independent risk factors in the multivariate analysis. We propose a prognostic score model based on these two risk factors. Patients within our criteria achieved a similar recurrence-free survival to patients within the Milan criteria. Seventy-one patients who were beyond the Milan criteria but within our criteria also had comparable survival to patients within the Milan criteria.ConclusionsTTV and L% are two risk factors that contribute to posttransplant recurrence. Selection criteria based on these two factors, which are proposed by our study, expanded the Milan criteria without increasing the risk of posttransplant recurrence.
Highlights
Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third leading cause of cancer-related death worldwide [1]
We propose a prognostic score model based on these two risk factors
Total tumour volume (TTV) and L% are two risk factors that contribute to posttransplant recurrence
Summary
Hepatocellular carcinoma (HCC) is the sixth most common neoplasm and the third leading cause of cancer-related death worldwide [1]. HCC recurrence after liver transplantation is a complication that negatively impacts the long-term survival of recipients. Patients with HCC within the Milan criteria and who undergo liver transplantation can achieve a similar long-term survival to patients with benign liver disease. The Milan criteria are too stringent and may deny HCC patients who may benefit from liver transplantation. Yao et al [4] confirmed appropriate expansion of the Milan criteria did not negatively impact HCC patient survival and expanded the Milan criteria to the University of California, San Francisco (UCSF) criteria (single tumour up to 6.5 cm in maximum diameter; or up to three tumours with none larger than 4.5 cm and with a total tumour diameter no more than 8 cm). We attempted to identify the risk factors associated with recurrence after liver transplantation
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.
