Living donor liver transplantation for hepatocellular carcinoma

Background: Liver transplantation is a widely accepted modality in the treatment of hepatocellular carcinoma (HCC). There are lots of criteria based on the numbers to determine the candidates for transplantation. The most widely used criteria is Milan. In our center, the patients with HCC limited to the liver and without macrovascular invasion are accepted to as candidates for living donor liver transplantation. The aim of this study is to describe patient characteristics and outcome from a single institution and analyze the effect of our criteria on survival of HCC patients.Patients and Methods: Medical records of all HCC (n=105) patients who underwent liver transplantation in our institution were reviewed. Died in the early postoperative period and undergone Deceased donor liver transplantation (DDLT) patients were excluded. The remaining 74 patients (65 male, 9 female) were analyzed. Median age was 53 (range, 19-69). Univariate Kaplan-Meier and multivariate cox proportional hazards model were used to analyze overall and disease-free survival.Results: Thirty-two (43 %) patients were within the Milan criteria, and 42 (57%) of them were exceeded. One and 2-year overall survival rates for the patients within and exceed the Milan criteria were, 72 % and 68 %, and 61 % and 58 %, respectively. One and 2 year disease-free survival rates for the patients within and exceed the Milan criteria were, 72 % and 68 %, and 60 % and 55 %, respectively (p>0.05). Tumor recurrence for the patients within and exceed the Milan criteria was 0% and 36 %, respectively (p = 0.0002). AFP level was the only predictor of overall survival, and AFP level and tumor differentiation were the predictors of disease-free survival.Conclusion: Although higher recurrence rates in the patients exceed the Milan criteria, living donor liver transplantation is the only treatment option for the patients in the countries with limited source of cadaveric organs. As a general principle, we believe that using of cadaveric liver grafts are not suitable for patients exceeding the criteria.