Are the criteria always right? Assessment of hepatocellular carcinoma cases in living donor liver transplantation at a high-volume center

Abstract

Background/Aim: With the increased experience in living donor liver transplantation (LDLT), it has been adopted for the treatment of hepatocellular carcinoma (HCC), with emerging discussions of criteria beyond tumor size and number. In contrast to deceased donor liver transplantation (DDLT), recipient selection for LDLT is not limited by organ allocation systems. We discuss here in the assessment, criteria and experience with LT in HCC cases at a high-volume LDLT center. Material and Methods: Between August 2006 and December 2017, 191 adult LT HCC recipients with at least one-year follow-up were retrospectively analyzed. Results: In 191 patients, one-, three-and five-year survival rates were 87.2%, 81.6%, and 76.2%. respectively, including early postoperative mortality. In 174 patients with long-term follow-up, one-, three-and five-year disease-free survival rates were 91.6%, 87.7% and 84.4%, respectively. When multivariate analysis was utilized tumor differentiation was the only factor which statistically affected survival (p=0.025). Conclusions: LDLT allows us to push the limits forward and the question "Are the criteria always right?" is always on the table. We can conclude that, with the advantage of LDLT, every HCC patient deserves a case-by-case basis discussion for LT under scientific literature support. In borderline cases, tumor biopsy might help determine the decision for LT.

Impact of Living Donor Liver Transplantation on the Improvement of Hepatocellular Carcinoma Treatment

“…We discussed our selection criteria and outcomes with a manuscript with my previous transplant team from Memorial Sisli Hospital, Istanbul, Türkiye. [38] In addition to our experience, many LDLT centers from Türkiye, Asian countries, and a few centers from Western countries published their results without any size and number limitations, but including biological behavior parameters and/or a case-bycase basis. [13][14][15][16][17][18][19][20][21][22][23][24][25][26][27] The University of Toronto group, a Western LT center, is one of the few centers that published their extended criteria with no tumor size and number limitation, showing the advantage of LDLT.…”

“…We discussed our selection criteria and outcomes with a manuscript with my previous transplant team from Memorial Sisli Hospital, Istanbul, Türkiye. [ 38 ] In addition to our experience, many LDLT centers from Türkiye, Asian countries, and a few centers from Western countries published their results without any size and number limitations, but including biological behavior parameters and/or a case-by-case basis. [ 13 - 27 ]…”