Effectiveness of Locoregional Therapy Before Living Donor Liver Transplantation in Patients With Hepatocellular Carcinoma Who Meet the Milan Criteria
ABSTRACT Many patients are diagnosed with hepatocellular carcinoma (HCC) within the Milan criteria. In Korea, these patients are preferentially treated with locoregional therapy (LRT) instead of living donor liver transplantation. We investigated the effectiveness of LRT in liver transplant recipients who met the Milan criteria at the time of HCC diagnosis and investigated risk factors for HCC recurrence.
We retrospectively reviewed the medical records of patients diagnosed with HCC who met the Milan criteria between 2002 and 2008.
We performed 101 liver transplants for HCC during the study period. Seventy-one patients (70%) underwent pretransplant LRT. The disease-free survival rates at 1, 3, and 5 years in patients who received LRT were 96.6%, 93.1%, and 93.1%, and in those who did not receive LRT, 94.2%, 83.4%, and 83.4%, respectively. There were no differences between the 2 groups. Multivariate analysis showed that a low Model for End-Stage Liver Disease (MELD) score and microvascular invasion were independent predictors of HCC recurrence after transplantation. The MELD scores and rate of microvascular invasion were not statistically different in patients with or without previous LRT.
Pretransplant LRT for patients with HCC who met the Milan criteria at the time of diagnosis did not provide a clear benefit with respect to HCC recurrence after transplantation. If patients have suitable living donors, those who meet the Milan criteria should undergo a liver transplantation as soon as possible.
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ABSTRACT: Upfront liver transplantation is the gold-standard in treatment of patients with hepatocellular carcinoma (HCC) and cirrhosis, but a shortage of donor organs negatively impacts on survival outcomes, with significant disease progression during long waiting lists. This systematic review evaluates the safety and efficacy of salvage liver transplantation as treatment for recurrent hepatocellular carcinoma after initial hepatic resection. Electronic searches of Pubmed, EMBASE and Medline databases identified 130 abstracts, from which 16 eligible studies comprising of 319 patients were selected for review. Studies adopting salvage liver transplantation (SLT) following primary hepatic resection for recurrent HCC, with more than five patients were included. Demographic details, morbidity and mortality indices and survival outcomes were collected from each study and tabulated. All patients included studies had liver cirrhosis, with the majority being Child-Pugh A (50%) and B (33%). The aetiology of liver disease was Hepatitis B in the majority of patients (84%). Disease recurrence occurred in 27-80% of patients at a median of 21.4 months (range 14.5-34) following initial resection. SLTs were performed on 41% of recurrences and were associated with biliary complications (8%), infection (11%), bleeding (8%) and vascular complications (7%). There were 18 peri-operative deaths (5.6%). The median 1, 3, and 5-year overall and disease-free survival was 89%, 80%, 62% and 86%, 68%, 67% respectively. Synthesis of available observational studies suggests that SLT following primary hepatic resection is a highly applicable strategy with long-term survival outcomes that are comparable to upfront liver transplantation.Journal of Gastroenterology and Hepatology 10/2013; DOI:10.1111/jgh.12399 · 3.33 Impact Factor