Living donor liver transplantation (LDLT) emerged as a major treatment option for patients with hepatocellular carcinoma (HCC) where cadaveric organ availability is limited. Optimum patient selection is very important in offering LDLT to patients with HCC. We aimed to evaluate the results of the patients undergoing LDLT for HCC classified within and beyond Milan criteria (MC). Between July 2004- July 2008 145 consecutive LDLT were performed in our center. Excluding three perioperative deaths and a case with non-cirrhotic fibrolamellar HCC, 37 patients (30 men, 17 women) were included in the analysis. Mean age was 54.6 years (range, 40-72 years). Preoperatively, all recipients underwent evaluation with CT/MRI. LDLT was considered for patients with negative metastatic work-up. The number and size of the lesions did not constitute an exclusion criteria per se. After pathological examination 18 patients were found to be within and 19 patients beyond MC. Mean follow-up was 24 months (range, 6-49 months). Preoperative mean alfa-fetoprotein level was significantly higher in patients with HCC beyond MC (60 vs. 321 ng/dL). Tumor differentiation was similar in both groups. HCC recurred in 8 patients (17.9%); 2 (11.1%) within and 6 (31.1%) beyond MC. There were 4 mortalities (2 HCC recurrences, 1 recurrent hepatitis C, and 1 caval thrombosis) which were all among the patients with HCC beyond MC. Estimated disease free survival in Kaplan-Meier analysis was significantly lower in patients with HCC beyond MC (32.8 vs. 41.2 months). In conclusion, LDLT offers early transplantation opportunity with excellent results in patients with HCC within MC. However, extension of MC in the setting of LDLT results in more patients with HCC being treated at the expense of a higher incidence of recurrence.
Volume : 6
Issue : 4
Pages : 23
Florence Nightingale Hospitals, Istanbul, Turkey