Living-donor<i>vs</i>deceased-donor liver transplantation for patients with hepatocellular carcinoma

Akamatsu, Nobuhisa; Sugawara, Yasuhiko; Kokudo, Norihiro

doi:10.4254/wjh.v6.i9.626

Cited by 27 publications

(18 citation statements)

References 38 publications

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“…Although curative hepatectomy and liver transplantation surgery are effective treatments for HCC [12], the risk of recurrence remains high with reported 3-year recurrence rates ranging from 40% to 70% after hepatectomy [13] and 20%–50% after living donor liver transplantation surgery [14]. Possible reasons for the high rates of recurrence after surgery include primary cancer cell dissemination, the survival of extravasated cancer cells (circulating tumor cells; CTCs) [15], the colonization capacity of CTCs [16], the number of CTCs expressing the membrane protein Thy-1 (CD90), a cancer stem/progenitor cell (CSPC) marker gene [17], and cancer cell mobility [18].…”

Section: Introductionmentioning

confidence: 99%

Androgen receptor mitigates postoperative disease progression of hepatocellular carcinoma by suppressing CD90+ populations and cell migration and by promoting anoikis in circulating tumor cells

et al. 2016

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PurposeAlthough hepatectomy and liver transplantation surgery for hepatocellular carcinoma (HCC) are effective treatment modalities, the risk of recurrence remains high, particularly in patients with a high number of circulating tumor cells (CTCs) expressing cancer stem/progenitor cell markers. Androgen receptor (AR) signaling has been shown to suppress HCC metastasis in rodent models of HCC. In this study, we investigated whether AR is associated with postoperative HCC recurrence.Experimental DesignCTCs were obtained from patients with HCC who had undergone hepatectomy to investigate whether they are associated with disease outcome. AR knockout was introduced in two mouse models of spontaneous HCC (carcinogen- and hepatitis B virus-related HCC) to delineate the role that AR plays in HCC recurrence. Biological systems analysis was used to investigate the cellular and molecular mechanisms.ResultsWe found that the expression of AR in CTCs was negatively associated with HCC recurrence/progression after hepatectomy. Our results suggest that AR-mediated suppression of HCC recurrence/progression is governed by a three-pronged mechanism. First, AR suppresses the expression of CD90 in CTCs by upregulating Histone 3H2A. Second, AR suppresses cell migration at the transcriptome level. Third, AR promotes anoikis of CTCs via dysregulation of cytoskeletal adsorption.ConclusionsThe results indicate that AR expression may be the gatekeeper of postoperative HCC recurrence. Therefore, targeting AR in presurgical down-staging procedures may serve as a secondary prevention measure against HCC recurrence in the future.

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Section: Introductionmentioning

confidence: 99%

Androgen receptor mitigates postoperative disease progression of hepatocellular carcinoma by suppressing CD90+ populations and cell migration and by promoting anoikis in circulating tumor cells

et al. 2016

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“…In this revew, they reported their original data about the association of graft liver regeneration with HCC recurrence. Their data suggested that there was no differences in the regeneration rate of graft liver between the recipients with HCC recurrence and those without recurrence (29).…”

Section: Recent Reportsmentioning

confidence: 98%

Living vs. deceased-donor liver transplantation for patients with hepatocellular carcinoma

Ogawa¹,

Takada²

2016

Transl. Gastroenterol. Hepatol.

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With the scarcity of deceased donor liver grafts, living donor liver transplantation (LDLT) is gaining popularity as an alternative to deceased donor liver transplantation (DDLT) for patients with hepatocellular carcinoma (HCC). However, as the evidence of cases of LDLT accumulates, several authors have reported higher HCC recurrence rates after LDLT. The suggested reasons for the higher recurrence rates following LDLT are related to the small-for-size graft in LDLT, surgical procedures that are specific to LDLT, and the fast-track to LDLT. Fast-tracking to LDLT may not allow sufficient time for evaluation of the biological aggressiveness of tumors, which may result in high recurrence rates due to inclusion of patients with more inherently aggressive tumors. Actually, some studies that reported higher recurrence rates with LDLT included a larger number of cases of HCC with microvascular invasion or poorly differentiated HCC. In order to exclude biologically aggressive HCC preoperatively, selection criteria incorporating tumor markers, such as alpha-fetoprotein (AFP) and des-gamma-carboxyprothrombin (DCP), as well as morphological tumor number and size have been proposed. With more reliable selection criteria incorporating biological markers to eliminate biologically aggressive HCC, LDLT can be a viable treatment option for patients with HCC, providing similar recurrence rates as those achieved with DDLT.

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“…Due to the severe organ shortage, living-donor liver transplantation (LDLT) has become mainstream in Eastern countries, with results that are comparable to those obtained by cadaveric-donor liver transplantation (CDLT) in Western countries [17]. Unlike CDLT, LDLT is not limited by the restrictions imposed by the nationwide allocation system, and the indication for LDLT in patients with HCC often depends on institutional or case-by-case considerations, balancing the burden on the donor, the operative risk, and the overall survival benefit for the recipient [18].…”

Section: The Eastern Perspectivementioning

confidence: 99%

Surgery and Hepatocellular Carcinoma

et al. 2016

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The optimal surgical strategy for hepatocellular carcinoma (HCC) is under active debate. Bio-markers of the liver functional reserve as well as volumetric analysis of the future liver remnant are essential for safe liver resection of HCC. The present algorithms applied to surgical strategies for HCC are not ideal because many patients who could potentially undergo safe resection are deemed liver transplant candidates in Western countries, whereas the opposite is the case in Eastern countries. In addition, there is too much focus on expanded criteria for patients with HCC to undergo liver transplantation. The transplantation benefit for patients with HCC should be considered based not only on the individual's benefit, but also on the effect of other patients waiting for LT for other indications.

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Living-donorvsdeceased-donor liver transplantation for patients with hepatocellular carcinoma

Cited by 27 publications

References 38 publications

Androgen receptor mitigates postoperative disease progression of hepatocellular carcinoma by suppressing CD90+ populations and cell migration and by promoting anoikis in circulating tumor cells

Androgen receptor mitigates postoperative disease progression of hepatocellular carcinoma by suppressing CD90+ populations and cell migration and by promoting anoikis in circulating tumor cells

Living vs. deceased-donor liver transplantation for patients with hepatocellular carcinoma

Surgery and Hepatocellular Carcinoma

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