The Stratifying Value of Hangzhou Criteria in Liver Transplantation for Hepatocellular Carcinoma

Jun Chen,Min Zhang,Xiao Xu,Yan Shen,Jian Wu,Shusen Zheng,Lin Zhou,Kai Wang,Haiyang Xie,Qi Ling,Weilin Wang,Lian-Yue Yang

doi:10.1371/journal.pone.0093128

Abstract

Background/AimsThe selection criteria for patients with hepatocellular carcinoma (HCC) as candidates for deceased donor liver transplantation (DDLT) are well studied. In this era of limited deceased donor organs, the value of living donor liver transplantation (LDLT) for HCC remains controversial. The aim of the present study was to verify the stratification value of the Hangzhou criteria for LDLT.MethodsThe data of 47 LDLT recipients and 94 matched DDLT recipients at our center were evaluated. Overall survival and tumor-free survival were calculated. Prognostic factors influencing post-liver transplantation (LT) survival were identified. The stratification values of the Hangzhou criteria and Milan criteria were compared.ResultsLDLT recipients spent much less time on the waiting list. The post-LT survival of recipients fulfilling the Milan criteria and recipients fulfilling the Hangzhou criteria were comparable (P>0.05). The overall and tumor-free survival did not differ statistically between the two groups. In both groups, more recipients not meeting the Milan criteria but with a satisfactory outcome were identified by the Hangzhou criteria. Among recipients who did not meet the Hangzhou criteria, tumor-free survival was better for the LDLT recipients than the DDLT recipients (P = 0.024).ConclusionsThe Hangzhou criteria are reliable for stratifying HCC patients in terms of prognosis. HCC patients fulfilling the Hangzhou criteria gain satisfactory survival from LT. Outcomes after LDLT are better than those after DDLT for HCC patients who do not meet the Hangzhou criteria.

Highlights

Hepatocellular carcinoma (HCC) is a common disease, with more than a half-million new cases occurring worldwide each year
The Milan criteria and UCSF criteria [3,4] and the Hangzhou criteria [5] have been shown to be successful in improving the outcomes of deceased donor liver transplantation (DDLT) for HCC performed at different centers and in persons of different racial backgrounds [6,7,8]
To the best of our knowledge, the establishment of reliable candidate selection criteria suitable for living donor liver transplantation (LDLT) in patients with HCC is feasible, it has not yet been done. Respecting this possibility, we retrospectively studied the cases of LDLT for HCC performed at our center with the goal of verifying the feasibility and selective value of the Hangzhou criteria in the context of LDLT

Summary

Introduction

Hepatocellular carcinoma (HCC) is a common disease, with more than a half-million new cases occurring worldwide each year. This makes it the fifth most common neoplasm in the world and the third major cancer killer [1]. Because the procedure may remove both the tumor and the entire cirrhotic background, liver transplantation (LT) is widely accepted as the treatment of choice for cirrhosis-related HCC. It might be the only life-saving procedure for patients with unresectable HCC and endstage liver disease. Respecting this possibility, we retrospectively studied the cases of LDLT for HCC performed at our center with the goal of verifying the feasibility and selective value of the Hangzhou criteria in the context of LDLT

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Conclusion