Living donor liver transplantation for hepatocellular carcinoma at the University of Tokyo Hospital

Togashi, Junichi; Akamastu, Nobuhisa; Kokudo, Norihiro

doi:10.21037/hbsn.2016.08.05

Cited by 21 publications

(17 citation statements)

References 39 publications

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“…In recent years, transplant centers have frequently applied more liberal criteria for selection of HCC patients, including the University of California San Francisco (UCSF) criteria, Shanghai Fudan criteria, and Hangzhou criteria . Using these wider criteria in after living‐donor transplantation, outcomes have been comparable to those achieved when applying the Milan criteria, consistent with studies based on predominantly deceased‐donor transplant populations . In the current trial, no eligibility restrictions were placed on the number or size of HCC nodules and only patients with extrahepatic spread or macrovascular invasion were excluded.…”

Section: Discussionmentioning

confidence: 59%

Efficacy and safety of everolimus with reduced tacrolimus in living-donor liver transplant recipients: 12-month results of a randomized multicenter study

Jeng

Lee

Soin³

et al. 2018

American Journal of Transplantation

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In a multicenter, open-label, study, 284 living-donor liver transplant patients were randomized at 30 ± 5 days posttransplant to start everolimus+reduced tacrolimus (EVR+rTAC) or continue standard tacrolimus (TAC Control). EVR+rTAC was non-inferior to TAC Control for the primary efficacy endpoint of treated BPAR, graft loss or death at 12 months posttransplant: difference -0.7% (90% CI -5.2%, 3.7%); P < .001 for non-inferiority. Treated BPAR occurred in 2.2% and 3.6% of patients, respectively. The key secondary endpoint, change in estimated glomerular filtration rate (eGFR) from randomization to month 12, achieved non-inferiority (P < .001 for non-inferiority), but not superiority and was similar between groups overall (mean -8.0 vs. -12.1 mL/min/1.73 m , P = .108), and in patients continuing randomized treatment (-8.0 vs. -13.3 mL/min/1.73 m , P = .046). In the EVR+rTAC and TAC control groups, study drug was discontinued in 15.5% and 17.6% of patients, adverse events with suspected relation to study drug occurred in 57.0% and 40.4%, and proteinuria ≥1 g/24 h in 9.3% and 0%, respectively. Everolimus did not negatively affect liver regeneration. At 12 months, hepatocellular recurrence was only seen in the standard TAC-treated patients (5/62; 8.1%). In conclusion, early introduction of EVR+rTAC was non-inferior to standard tacrolimus in terms of efficacy and renal function at 12 months, with hepatocellular carcinoma recurrence only in TAC Control patients. ClinicalTrials.gov Identifier: NCT01888432.

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Section: Discussionmentioning

confidence: 59%

Efficacy and safety of everolimus with reduced tacrolimus in living-donor liver transplant recipients: 12-month results of a randomized multicenter study

Jeng

Lee

Soin³

et al. 2018

American Journal of Transplantation

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“…All 3 expanded the inclusion criteria of HCC patients for LT based on the combination of morphological tumor aspects and biological tumor behavior expressed by DCP and/or AFP secretion. The “Tokyo HCC-LT Criteria” include patients presenting with ≤5 tumors, each tumor having a diameter of ≤5 cm, in combination with AFP and DCP levels of ≤250 ng/mL and ≤450 mAU/mL, respectively (10, 14). The “Kyoto HCC-LT Criteria” include patients presenting ≤10 tumors, all having a diameter of ≤5 cm, in combination with a DCP level of ≤400 mAU/mL (11, 15-17).…”

Section: Discussionmentioning

confidence: 99%

Des-Gamma-Carboxy Prothrombin in Hepatocellular Cancer Patients Waiting for Liver Transplant: A Systematic Review and Meta-Analysis

et al. 2017

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“…The 5-year recurrence rates were 8% for Milan-out Tokyo-in patients and 6% for Milan-in patients. The OS and DFS rates were comparable between the two groups[ 54 ].…”

Section: Introductionmentioning

confidence: 99%

Expansion of the hepatocellular carcinoma Milan criteria in liver transplantation: Future directions

Pavel

Fuster

2018

WJG

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Milan criteria are currently the benchmark related to liver transplantation (LT) for hepatocellular carcinoma. However, several groups have proposed different expanded criteria with acceptable results. In this article, we review the current status of LT beyond the Milan criteria in three different scenarios-expanded criteria with cadaveric LT, downstaging to Milan criteria before LT, and expansion in the context of adult living donor LT. The review focuses on three main questions: what would the impact of the expansion beyond Milan criteria be on the patients on the waiting list; whether the dichotomous criteria (yes/no) currently used are appropriate for LT or continuous survival estimations, such as the one of “Metroticket” and whether it should enter into the clinical practice; and, whether the use of living donor LT in the context of expansion beyond Milan criteria is justified.

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Living donor liver transplantation for hepatocellular carcinoma at the University of Tokyo Hospital

Cited by 21 publications

References 39 publications

Efficacy and safety of everolimus with reduced tacrolimus in living-donor liver transplant recipients: 12-month results of a randomized multicenter study

Efficacy and safety of everolimus with reduced tacrolimus in living-donor liver transplant recipients: 12-month results of a randomized multicenter study

Des-Gamma-Carboxy Prothrombin in Hepatocellular Cancer Patients Waiting for Liver Transplant: A Systematic Review and Meta-Analysis

Expansion of the hepatocellular carcinoma Milan criteria in liver transplantation: Future directions

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