Living donor liver transplantation for adult patients with hepatocellular carcinoma - Experience in Japan

Objective: We sought to determine the outcome of living donor liver transplantation (LDLTx) in 316 adult patients with hepatocellular carcinoma (HCC). Summary Background Data: LDLTx has increasingly been performed worldwide, but the impact of the procedure on HCC has not been evaluated in a large series. Methods: Between October 1989 and December 2003, 1389 adults underwent LDLTx at 49 centers in Japan. In 316 (22.8%) who received LDLTx for HCC (70 females, 22%, median age 57 years; and 246 males, 88%, median age, 54 years), we analyzed pre-transplant clinical status, imaging diagnosis, transplant procedure, pathologic study of explanted liver, and outcome. In 232 patients (73.4%), various surgical and nonsurgical therapies had been employed prior to LDLTx. The median follow-up period was 16 months (range, 2.5-72.0) Results: Currently, 236 (74.7%) of the patients are living. One- and 3-year patient survivals were 78.1% and 69.0%, respectively. Model end-stage liver disease score and preoperative serum alpha-fetoprotein level were independent risk factors for patient survival. Forty patients (12.7%) developed HCC recurrence. Alpha-fetoprotein level, tumor size, vascular invasion, and bilobar distribution were independent risk factors for HCC recurrence. Grade of histologic differentiation of HCC showed close correlation with tumor characteristics and recurrence. One- and 3-year recurrence-free survivals were 72.7% and 64.7%, respectively. When the Milan criteria were applied, patient survival and disease-free survival at 3 years were 78.7% and 79.1%, respectively, in patients who met the criteria, and 60.4% and 52.6%, respectively, in those who did not. Conclusion: LDLTx can achieve acceptable survival in HCC patients, even when liver function is markedly impaired, or HCC is uncontrollable by conventional antitumor treatments.