Predictor of outcome after living donor liver transplantation for patients with hepatocellular carcinoma beyond the Japan criteria

Abstract

Background The Japan criteria (JC, maximum tumor size within 5 cm, within five tumor nodules, AFP within 500 ng/mL or within Milan criteria) have been applied to cadaveric liver transplantation (LT) for hepatocellular carcinoma (HCC) and will be used for living donor LT (LDLT) in Japan. The aim of this study was to verify the JC in LDLT and to clarify the risk factor of HCC recurrence and mortality after LDLT beyond the JC. Patients and methods Adult patients who underwent LDLT for end‐stage liver disease with HCC until October 2019 were reviewed retrospectively (n = 246). Patients were divided into two groups according to whether they were within JC (n = 203) or beyond JC (n = 43). Recurrence‐free or overall survival rates after LDLT were compared. Univariate and multivariate analyses were performed to identify risk factors of HCC recurrence and HCC‐related mortality after LDLT for patients beyond the JC. Results Patients beyond the JC had significantly poorer 5‐year recurrence‐free (50.3% vs 95.9%, P < .001) or overall (61.7% vs 98.1%, P < .001) survival rates compared with patients within the JC. A multivariate analysis revealed that des‐gamma‐carboxy prothrombin (DCP) ≥ 300 mAU/mL (hazard ratio 9.36, 95% CI; 2.41‐36.4, P = .001) was an independent risk factor for HCC recurrence and HCC‐related mortality (hazard ratio 13.8, 95% CI; 1.92‐98.6, P = .01) after LDLT in patients beyond the JC. Conclusion The outcome of LDLT for patients within the JC was favorable. Patients beyond the JC with DCP ≥ 300 mAU/mL might be contraindicated for LDLT.

Clinical significance of mechanistic target of rapamycin expression in vessels that encapsulate tumor cluster‐positive hepatocellular carcinoma patients who have undergone living donor liver transplantation

“…1 Hepatic resection is performed as a curative treatment for HCC, but liver transplantation (LT) has been accepted as the effective treatment strategy with strict adherence to the widely used Milan criteria. [2][3][4] Despite the high incidence of HCC recurrence within the LT population, there is no established evidence to guide specific post-LT surveillance strategies. Almost all LT patients require immunosuppressive medication, which lowers their anti-tumor immunity and frequently leads to intrahepatic or extrahepatic HCC recurrence.…”

Low syntaxin 17 expression in donor liver is associated with poor graft prognosis in recipients of living donor liver transplantation

“…4 To overcome this organ shortage, living donor LT (LDLT) have been performed since 1989, 5,6 and the number of LDLT performed is increasing worldwide. [7][8][9] Graft failure is a life threating complication, [10][11][12] and graft size and quality are two correlates of graft failure. 9 We previously reported useful predictors of graft failure after LDLT, including the graft volume-to-standard liver volume (GV/SLV) ratio, donor age, Model for End-Stage Liver Disease (MELD) score, splenectomy, and the presence of a portosystemic shunt.…”

“…The number of patients awaiting LT far outnumber the available allografts; thus organ shortage is a major treatment obstacle 4 . To overcome this organ shortage, living donor LT (LDLT) have been performed since 1989, 5,6 and the number of LDLT performed is increasing worldwide 7–9 . Graft failure is a life threating complication, 10–12 and graft size and quality are two correlates of graft failure 9 .…”

Liver Transplant Outcomes After Downstaging to Within Milan Criteria—Balancing Patient Benefit With Resource Allocation

“…Hepatology. 2019;70 (4) Liver transplant is a major medical advancement of the 20th century, providing effective treatment for liver diseases, including metabolic disease, viral infection, and liver cancers. 1 Allocating donated livers across geographic lines and patient groups is an arduous process for leaders in the field and for public health experts.…”

“…Although the MC are beneficial partly because of their simplicity, many factors help to stratify patients with regard to cancer recurrence risk, including a waiting period of 6 months, desγ-carboxy prothrombin levels, 4 and peak α-fetoprotein levels. 5 Milan criteria plus a 6-month waiting period will likely remain a universally used criterion for most transplants in patients with cancer.…”