Living-Donor Liver Transplantation Associated With Higher Incidence of Hepatocellular Carcinoma Recurrence Than Deceased-Donor Liver Transplantation

Park, Min Su; Lee, Kwang Woong; Suh, Sanggyun; You, Tae; Choi, Young Rok; Kim, Hye Young; Hong, Geun; Yi, Nam Joon; Kwon, Choon Hyuck David; Joh, Jae‐Won; Lee, Suk Koo; Suh, Kyung Suk

doi:10.1097/tp.0b013e3182a68953

Cited by 70 publications

(61 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We also reported that LDLT showed worse outcomes than DDLT among patients within the UCSF criteria when having poor tumor biology (high AFP, microvascular invasion, high histological grade). This may be due to different clinical characteristics of LDLT such as a fast-track effect and graft regeneration (12). Based on these results, conventional criteria from DDLT based analysis, such as Milan criteria and UCSF criteria, focusing on tumor number and size are not similarly effective to stratify survival in LDLT.…”

Section: Discussionmentioning

confidence: 94%

“…Dynamic liver CT or MRI, chest CT, and bone scan including serum tumor markers were checked every 3 to 6 months for the first one and a half year depending on the risk factors such as high AFP, microvascular invasion, and high histological grade, and every 6 months to 1 year thereafter (11,12). PET was also performed for patients with a high-risk of recurrence, such as patients who did not meet the Milan criteria, and patients with increasing tumor markers without abnormal liver function.…”

Section: Post-transplantation Management and Follow-upmentioning

confidence: 99%

See 1 more Smart Citation

Living donor liver transplantation for hepatocellular carcinoma in Seoul National University

Hong¹,

Lee²,

Kim³

et al. 2016

Hepatobiliary Surg. Nutr.

Self Cite

View full text Add to dashboard Cite

Background: Liver transplantation is an effective treatment modality for hepatocellular carcinoma (HCC).Due to deceased organ shortage, living donor liver transplantation (LDLT) accounts for the majority of liver transplants in Korea. The aim of this study is to evaluate the recent trend of LDLT for HCC, and to suggest guidelines and criteria for selecting the appropriate candidates for LDLT.Methods: Between January 2000 and December 2015, 532 patients underwent LDLT for HCC.Clinicopathologic data were analyzed as well as overall survival rate (SR) and disease-free survival rate (DFSR) according to the Milan criteria based on explant pathology, positron emission tomography (PET) positivity, and serum alpha-fetoprotein (AFP) level. Results:The 5-year overall SR and DFSR were 81.5% and 75.5% respectively. According to our previously reported combination of AFP and PET [Seoul National University Hospital (SNUH) criteria]; low risk group [AFP <200 ng/mL, PET (−)], intermediate risk group [AFP >200 ng/mL, PET (−) or AFP <200 ng/mL, PET (+)], and high risk group [AFP >200 ng/mL, PET (+)], the 5-year DFSR of low risk group was 86.1%, intermediate risk group was 79.0%, and high risk group was 18.5% (P<0.001). Within the Milan criteria, the 5-year DFSR of low risk group was 88.4%, intermediate risk group was 79.9%, and high risk group was 60.0% (P=0.016). Beyond the Milan criteria, the 5-year DFSR of low, intermediate, and high risk group was 80.3%, 77.7%, and 9.1%, respectively (P<0.001). Conclusions:In conclusion, our data and experience suggest that a continued paradigm shift from a conventional size based criteria to a biological marker based criteria is indicated when evaluating LDLT candidates with HCC.

show abstract

Section: Discussionmentioning

confidence: 94%

Section: Post-transplantation Management and Follow-upmentioning

confidence: 99%

Living donor liver transplantation for hepatocellular carcinoma in Seoul National University

Hong¹,

Lee²,

Kim³

et al. 2016

Hepatobiliary Surg. Nutr.

Self Cite

View full text Add to dashboard Cite

show abstract

“…Studies reporting a poorer outcome in the LDLT setting Park et al [10] recently reported poorer recurrence-free survival among 166 LDLT recipients (81% at 5 years) compared to 50 DDLT recipients (94% at 5 years; P = 0.045). The noteworthy finding of this study was that the smaller the LDLT graft, the poorer the recurrence -free survival.…”

Section: For Hcc Patientsmentioning

confidence: 99%

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

Akamatsu

Sugawara

Kokudo

2014

WJH

View full text Add to dashboard Cite

With the increasing prevalence of living-donor liver transplantation (LDLT) for patients with hepatocellular carcinoma (HCC), some authors have reported a potential increase in the HCC recurrence rates among LDLT recipients compared to deceased-donor liver transplantation (DDLT) recipients. The aim of this review is to encompass current opinions and clinical reports regarding differences in the outcome, especially the recurrence of HCC, between LDLT and DDLT. While some studies report impaired recurrence -free survival and increased recurrence rates among LDLT recipients, others, including large database studies, report comparable recurrence -free survival and recurrence rates between LDLT and DDLT. Studies supporting the increased recurrence in LDLT have linked graft regeneration to tumor progression, but we found no association between graft regeneration/initial graft volume and tumor recurrence among our 125 consecutive LDLTs for HCC cases. In the absence of a prospective study regarding the use of LDLT vs DDLT for HCC patients, there is no evidence to support the higher HCC recurrence after LDLT than DDLT, and LDLT remains a reasonable treatment option for HCC patients with cirrhosis.© 2014 Baishideng Publishing Group Inc. All rights reserved.Key words: Deceased donor liver transplantation; Hepatocellular carcinoma; Living donors; Living-donor liver transplantation; RecurrenceCore tip: The current opinions and clinical reports regarding differences in the recurrence of hepatocellular carcinoma (HCC) between living donor liver transplantation (LDLT) and deceased donor liver transplantation (DDLT) were reviewed. In the absence of a prospective study regarding the use of LDLT vs DDLT for HCC patients, only with some retrospective studies with conflicting results, there is no evidence to support the higher HCC recurrence after LDLT than DDLT, and LDLT remains a reasonable treatment option for HCC patients with cirrhosis.Akamatsu N, Sugawara Y, Kokudo N. Living-donor vs deceaseddonor liver transplantation for patients with hepatocellular carcinoma. World J Hepatol 2014; 6(9): 626-631 Available from:

show abstract

“…In 2014, Park et al (17) reported the results of 216 OLT recipients with HCC who met the UCSF criteria (166 LDLT and 50 DDLT). Recurrence-free survival was significantly lower with LDLT compared to DDLT (88.6% and 80.7% vs. 96.0% and 94.0% at 1-and 5-year, P=0.045).…”

Section: Recent Reportsmentioning

confidence: 99%

“…Therefore, LDLT for patients with HCC is being accepted worldwide as a solution to donor shortage and waiting list mortality (11,12). However, with the accumulation of cases, higher recurrence rates after LDLT in comparison to DDLT have been reported by several authors (13)(14)(15)(16)(17). In this review, we aim to present a current overview of the outcomes of LDLT compared to those of DDLT in patients with HCC, with emphasis on the recurrence of HCC.…”

Section: Introductionmentioning

confidence: 99%

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

Ogawa¹,

Takada²

2016

Transl. Gastroenterol. Hepatol.

View full text Add to dashboard Cite

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.

show abstract

Living-Donor Liver Transplantation Associated With Higher Incidence of Hepatocellular Carcinoma Recurrence Than Deceased-Donor Liver Transplantation

Abstract: In conclusion, LDLT showed poorer outcome than DDLT. This should be considered to select optimal strategy for HCC.

Cited by 70 publications

References 15 publications

Living donor liver transplantation for hepatocellular carcinoma in Seoul National University

Living donor liver transplantation for hepatocellular carcinoma in Seoul National University

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

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

Contact Info

Product

Resources

About