The role of living-donor liver transplantation in surgical treatment for hepatocellular carcinoma

Yokoi, Hiroyoshi; Isaji, Shuji; Yamagiwa, Kentaro; Tabata, Masami; Nemoto, Akiyoshi; Sakurai, Hiroyuki; Usui, Miki; Üemoto, Shinji

doi:10.1007/s00534-005-1018-8

Cited by 21 publications

(8 citation statements)

References 27 publications

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“…99 Indeed, in 9 studies, patients with chronic hepatitis and cirrhosis who met the MC and underwent LT for HCC achieved posttransplant survival rates comparable to those of patients with nontumor indications for LT. Although they were not designed to specifically address a survival equivalence between LT patients within the MC and LT patients with nontumor indications, 4 prospective cohort studies (level 1b) 2,10,11,13 and 5 retrospective cohort studies 29,32,39,45,46 (level 2b) reported 5-year survival rates of 65% to 78% for patients meeting the MC and 68% to 87% for patients with nontumor indications. The European Liver Transplant Registry, the Organ Procurement and Transplantation Network, and the Australian and New Zealand Liver Transplant Registry 100-102 have confirmed survival rates of 70% to 82% for patients with nontumor indications.…”

Section: And Nontumor Indicationsmentioning

confidence: 99%

“…The meta-analysis included 19 studies 2,15,16,19,26,33,35,39,40,42,46,48,[53][54][55]57,63,67,84 that used different methodologies to compare the overall survival of patients meeting the MC and patients exceeding the criteria at the time of the explant pathology examination; 3949 patients were also stratified by the graft origin (deceased or living donors).…”

Section: And Transplantation For Patients With Hcc Beyond Conventimentioning

confidence: 99%

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Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

Mazzaferro

Bhoori²,

Sposito³

et al. 2011

Liver Transpl

508

322

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Section: And Nontumor Indicationsmentioning

confidence: 99%

Section: And Transplantation For Patients With Hcc Beyond Conventimentioning

confidence: 99%

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

Mazzaferro

Bhoori²,

Sposito³

et al. 2011

Liver Transpl

508

322

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“…Recently, the indication of living-donor liver transplantation has been greatly expanded for HCC beyond the Milan criteria [10]. Salvage living-donor liver transplantation has also been performed in patients with untreatable HCC by conventional treatments or in cirrhotic patients with ChildPugh class B or C [11]. The demand for liver transplantation by HCC patients has increased worldwide [12].…”

Section: Introductionmentioning

confidence: 99%

Long-Term Outcome of Splenectomy in Advanced Cirrhotic Patients with Hepatocellular Carcinoma and Thrombocytopenia

et al. 2013

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Summary: Splenectomy may be a treatment option in hepatocellular carcinoma (HCC) and cirrhosis when there is no potential donor for liver transplantation. We retrospectively investigated the long-term outcome of splenectomy on survival in advanced cirrhotic patients with HCC and thrombocytopenia. Between 1999 and 2009, 46 cirrhotic patients with thrombocytopenia (Child-Pugh class B or C) who underwent splenectomy for the simultaneous or secondary treatment of HCC at our institute were evaluated. The 1-, 3-, and 5-year survival rates were 93.5, 76.0, and 37.9%, respectively. Splenectomy resulted in a significant reduction in mean portal venous pressure from 21.2 to 16.8 mmHg and improvements in liver function tests such as total bilirubin, prothrombin time, platelet count, Child-Pugh score for 3 years, and albumin for 2 years. The mean frequency of treatment for HCC recurrence after surgery was 3.0 times (range 1-11). Seven patients out of 16 scheduled for Interferon (IFN) therapy after surgery achieved a sustained virological response (SVR). Multivariate analysis identified SVR after IFN therapy as an independent significant prognostic factor (Hazard ratio 0.18, 95%CI 0.03-0.65, P=0.006). Postoperative complications including liver failure (n=1), portal thrombosis (n=7), ascites (n=5), and bacterial infections (n=4) were observed in 14 patients (30%). Splenectomy can be a feasible supportive therapy for the continuation of anticancer therapy and completion of IFN therapy based on improvements in liver function and thrombocytopenia with minimum complications in patients with HCC and advanced cirrhosis with no potential donor.

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“…While LDLT is a life saving procedure for the recipient, it is a potentially lethal operation for the donor. Therefore, very stringent criteria have to be fulfilled prior to hepatectomy to ensure donor safety [9][10][11] . For the donor, fast liver regeneration is imperative to reduce the probability of liver insufficiency [12,13] .…”

Section: Introductionmentioning

confidence: 99%

Extent of liver resection modulates the activation of transcription factors and the production of cytokines involved in liver regeneration

Sowa¹,

Best²,

Benkő³

et al. 2008

WJG

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AIM:To investigate the molecular events involved in liver regeneration following subtotal hepatectomy (SH) as previous studies have largely focused on partial hepatectomy (PH). METHODS:Male Wistar rats were subjected to 70% PH or 90% SH, respectively, and sacrificed at different times after surgery. Untreated and sham-operated animals served as controls. Serum and liver samples were obtained to investigate liver function, apoptosis (TUNEL assay) and transcription factors (NF-κB, Stat3; ELISA) or cytokines (HGF, TNF-a, IL-6, TGF-a, TGF-b; quantitative RT-PCR) involved in liver regeneration. RESULTS:Serum levels of ALT and AST in animals with 70% PH differed significantly from sham-operated and control animals. We found that the peak concentration 12 h after surgery returned to control levels 7 d after surgery. LDH was increased only at 12 h after 70% PH compared to sham. Bilirubin showed no differences between the sham and 70% resection. After PH, early NF-κB activation was detected 12 h after surgery (313.21 ± 17.22 ng/mL), while there was no activation after SH (125.22 ± 44.36 ng/mL) compared to controls (111.43 ± 32.68 ng/mL) at this time point. In SH, however, NF-κB activation was delayed until 24 h (475.56 ± 144.29 ng/mL). Stat3 activation was similar in both groups. These findings correlated with suppressed and delayed induction of regenerative genes after SH (i.e. TNF-a 24 h postoperatively: 2375 ± 1220 in 70% and 88 ± 31 in 90%; IL-6 12 h postoperatively: 2547 ± 441 in 70% and 173 ± 82 in 90%). TUNEL staining revealed elevated apoptosis rates in SH (0.44% at 24 h; 0.63% at 7 d) compared to PH (0.27% at 24 h; 0.15% at 7 d). CONCLUSION:The molecular events involved in liver regeneration are significantly influenced by the extent of resection as SH leads to suppression and delay of liver regeneration compared to PH, which is associated with delayed activation of NF-κB and suppression of proregenerative cytokines.

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The role of living-donor liver transplantation in surgical treatment for hepatocellular carcinoma

Cited by 21 publications

References 27 publications

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

Milan criteria in liver transplantation for hepatocellular carcinoma: An evidence-based analysis of 15 years of experience

Long-Term Outcome of Splenectomy in Advanced Cirrhotic Patients with Hepatocellular Carcinoma and Thrombocytopenia

Extent of liver resection modulates the activation of transcription factors and the production of cytokines involved in liver regeneration

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