Living Donor Liver Transplantation for Hepatocellular Carcinoma in Patients Exceeding the UCSF Criteria

• Published in: Transplantation proceedings 2008-11, Vol.40 (9), p.3185-3188
• Main Authors: Fouzas, I, Sotiropoulos, G.C, Lang, H, Nadalin, S, Beckebaum, S, Sgourakis, G, Saner, F.H, Radtke, A, Papanikolaou, V, Baba, H.A, Paul, A, Broelsch, C.E, Malagó, M
• Format: Article
• Language: English
• Subjects: Adult; Biological and medical sciences; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - surgery; Disease-Free Survival; Female; Fundamental and applied biological sciences. Psychology; Fundamental immunology; Gastroenterology. Liver. Pancreas. Abdomen; Humans; Liver Neoplasms - mortality; Liver Neoplasms - surgery; Liver Transplantation - mortality; Liver Transplantation - pathology; Liver Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Living Donors - supply & distribution; Male; Medical sciences; Middle Aged; Neoplasm Staging; Patient Selection; Surgery; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Rate; Survivors; Time Factors; Tissue, organ and graft immunology; Tumors
• ISSN: 0041-1345; 1873-2623
• DOI: 10.1016/j.transproceed.2008.08.036

Abstract Background Living donor liver transplantation (LDLT) represents an alternative to expand the organ pool for adult patients with hepatocellular carcinoma (HCC) and end-stage liver disease. The purpose of this study was to demonstrate our institutional experience using criteria exceeding those of the University of California San Francisco (UCSF). Patients and Methods Between September 1998 and December 2006, 22 LDLTs were performed for HCC among patients exceeding the UCSF criteria. Results There were 17 men and 5 women of median age 55 years. Multifocal tumors were present in 19 of 22 patients. Tumor grading was: grade I (n = 8), grade II (n = 10), and grade III (n = 4). Microvascular invasion was observed in 7 liver explants. Five patients died from complications unrelated to HCC recurrence at 2, 6, 9, 10, and 14 months' posttransplant. Seven patients developed tumor recurrences at 3, 3, 5, 7, 9, 10, and 35 months after LDLT, and 4 died at 6, 10, 17, and 75 months' posttransplantation. Currently, 13 patients are alive (3 with tumor recurrence) at a median of 24 months' posttransplant. Rates for 1- and 3-year overall versus recurrence-free survivals were 73% and 62% versus 54% and 34%, respectively. Conclusions LDLT for HCC patients exceeding the UCSF criteria is characterized by an acceptable overall but poor recurrence-free survival. Its application requires an honest approach to donor and recipient information.