Purpose: The purpose of this study was to evaluate the possibility of expanding the indicationfor living donor liver transplantation (LDLT) for treatment of hepatocellular carcinoma (HCC),beyond the Milan critena without compromising patient survival.
Methods: This was a retrospective study of Spatients (36.4%) that had undergone LDLT,beyond the Milan criteria, among 143 patients with HCC. The study was conducted in patientstreated by the Department of Surgery, Catholic University of Korea from Oct 2000 to May2008. We evaluated the survival curve, Prognostic factors for survival and compared survivalbetween our new ciitena and Milan chtena.
ResuHs: The 5 year patient survival and disease free survival rate in patients treated withLDLT beyond the Milan critena were 50.2% and 61.9%, respectively. The prognostic factorsaffecting disease free survival and patient survival included serum AFP level, tumor size,vascular invasion, and tumor cell differentiation on univanate analysis, In multivanate analysis,AFP (200 ng/mL), tumor size (7 cm) and vascular invasion had significant influence onsurvival and disease free survival. According to our new critena (size <7 cm, AFP <200ng/mL), 88.1% of our patients were included compare to the 63.6% that would have been iflimited to the Milan chtena. With both factors met, the survival was comparable to the survivalof Milan chtena (63.7% on our criteha and 78.2% on Milan criteha at 5 years) (P =0.103).
Conclusion: A tumor size <7 cm and an AFP < 200 ng/mL appear to be useful cut-off values,beyond that criteria required by Milan. An analysis according to our criteria showed anacceptable survival outcome. Further verification of these findings by a large volume orprospective study is required forwidespread adoption ofour new criteria.
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