Liberal selection criteria for liver transplantation for hepatocellular carcinoma

Background: To help increase the number of transplants available for hepatocellular carcinoma in cirrhotic livers, this single-centre retrospective study compared the safety and feasibility of new, more liberal, selection criteria - no more than five tumours, with the largest tumour no greater than 5 cm (5/5 criteria) - with classical criteria. Methods: Data from operations performed in 1990-2005 were extracted from preoperative radiological findings and postoperative specimen analyses, and four groups were constructed: Paul Brousse, Milan, University of California, San Francisco (UCSF) and 515 criteria. A fifth group comprised patients whose tumour load exceeded the 515 criteria. Survival and recurrence rates were compared. Results: For the 110 patients in the study, survival rates (overall and disease-free) were 72.8 and 66.8 per cent at 5 and 10 years respectively, with a 5.5 per cent recurrence rate. The 5-year survival rate was 65, 77, 68 and 77 per cent for Paul Brousse, Milan, UCSF and 5/5 preoperative radiological criteria, with recurrence rates of 4, 4, 3 and 3 per cent, respectively. On multivariable analysis, the only factor that influenced survival was tumour load in excess of the 5/5 criteria. Conclusion: Use of the more liberal 5/5 criteria for selecting patients for liver transplantation results in similar disease-free and overall survival rates to classical criteria.