Impact of pretreatments on outcomes after living donor liver transplantation for hepatocellular carcinoma

Abstract

Background The purpose of this study was to examine the impact of pretreatments on outcomes after living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC). Methods From February 1999 to March 2015, 223 patients underwent LDLT for HCC. Until December 2006, there was no restriction in patient selection criteria regarding the number and size of tumors, following which we implemented the Kyoto criteria (tumor number ≤10, maximal diameter ≤5 cm, and des‐gamma‐carboxy prothrombin ≤400 mAU/ml) since January 2007. Results Of 223 patients, 156 had a history of pretreatments. Among 101 patients meeting the Milan criteria at the initial diagnosis, 38 progressed to beyond the criteria at liver transplantation (LT). Twenty‐two out of 38 met the Kyoto criteria, and their survival and recurrence rates were significantly better than those of patients exceeding the Kyoto criteria (P = 0.004 and 0.035, respectively). Regarding the number of pretreatments (0 vs. 1–4 vs. ≥5), recurrence rate was significantly higher in the ≥5 pretreatments group than the 0 group. However, for patients meeting the Kyoto criteria, there were no significant differences in recurrence rates between these three groups. Conclusion Better outcomes will be achieved by performing LT for HCCs meeting the Kyoto criteria even after repeated pretreatments.

Salvage living donor liver transplantation for hepatocellular carcinoma recurrence after hepatectomy: Quantitative prediction using ADV score

“…However, when confined to the patients meeting the Kyoto criteria, 22 the number of pretreatments did not show a significant difference in recurrence rates. 34 Reliable quantitative prediction of posttransplant HCC recurrence is helpful to make decisions about treatment options before LDLT as well as when choosing tailored protocols for surveillance studies and immunosuppressive regimens. In HCC patients showing very high ADV scores, for example >8log, early posttransplant tumor recurrence may negate the benefits of LDLT, thus LDLT should be decided after prudent consideration.…”

Absence of influence of the Korean MELD score-based liver allocation system on pretransplant MELD score in patients undergoing living donor liver transplantation

“…To the best of our knowledge, the present study is the first study to present the details of MELD scores in LDLT recipients with and without HCC. The median or mean values of MELD score in the reported LDLT series were 15 (range: 3-43) in 223 patients (Kyoto University, Japan) [14]; 12.4±4.0 in 165 patients (Memorial Atasehir Hospital, Turkey) [15]; 13.0 (range: 11.9-14.0) in 90 patients (Kyushu University, Japan) [16]; 11 (range: 8-14) in 348 patients (Kaohsiung Chang Gung Memorial Hospital, Taiwan) [17]; and 13 (range: -1-46) in 134 patients (Samsung Medical Center, Korea) [18].…”

Liver Transplantation for Hepatocellular Carcinoma: How Should We Improve the Thresholds?

“…Additionally, despite locoregional therapy, an AFP slope >7.5 ng/mL per month was associated with HCC recurrence post-transplantation (HR, 3.0, p = 0.03) [ 88 ]. A study of LDLT from a Kyoto group showed that the number of pre-transplant treatments, including resection and locoregional therapies, could predict the risk of HCC recurrence post-transplantation, with patients who had undergone ≥5 pre-transplant treatments showing a higher 5-year recurrence rate than others (30% vs. 7% no pre-transplant treatment, p = 0.09) [ 89 ]. Thus, the response to locoregional therapy is closely correlated with post-transplant HCC recurrence.…”