Liver transplantation for hepatocellular carcinoma: the Kyoto experience

Background/purpose The results of living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) at Kyoto University were analyzed. Methods Between February 1999 and December 2006, 136 patients with HCC underwent LDLT. Of these, 74 patients met the Milan criteria, while 62 patients did not. Treatment for HCC had been previously performed prior to LDLT for 101 patients (74%). Results According to the results of multivariate analysis of risk factors for recurrence among preoperative tumor variables, we have defined new Kyoto criteria as <= 10 tumors all <= 5 cm in diameter and protein induced by vitamin K absence or antagonist-II (PIVKA-II) <= 400 mAU/ml. The 5-year recurrence rate was significantly lower for the 85 patients who met the Kyoto criteria than for the 45 patients who exceeded them (3 vs. 54%, p < 0.0001). Similarly, patients who met the Kyoto criteria showed a significantly better 5-year survival rate (87%) than those who did not (36%, p < 0.0001). Survival rates did not differ between pretreated and primary groups, and recurrence rates were similarly low when limited to patients who met the Kyoto criteria. Conclusions The proposed Kyoto criteria are expected to serve efficiently as expanded selection criteria for LDLT in patients with HCC. History of previous treatments did not affect outcomes after LDLT.