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Survival Analysis after Adult Living Donor Liver Transplantation for Hepatocellular Carcinoma according to Milan Criteria

Na, Byung-Gon; Lee, Eung Chang; Kim, Seong Hoon; Park, Sang Jae

doi: 10.1097/01.tp.0000543984.56933.60
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Introduction The aim of the present study was to compare the clinical outcomes after living-donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC) according to Milan criteria.

Materials and Methods Between Jan 2005 and Dec 2015, a total of 419 patients underwent LDLT for HCC. Clinico-pathologic data were retrospectively analyzed for overall survival rate (OS) and recurrence free survival rate (RFS) according to Milan criteria based on explant liver pathology. In terms of Milan criteria, subgroup analysis for risk factors of recurrence was performed.

Results The 1-, 3-, 5-year OS of within Milan (WM) group and beyond Milan (BM) group were 95.7%, 88%, 85.8% and 68.3%, 65.9%, 65.9%, respectively (P < 0.0001). Overall survival rate was better in the WM group than BM group [hazard ratio (HR) 2.25, 95% confidence interval (CI) 1.52–3.32, P < 0.0001]. The 1-,3-,5-year RFS in WM group were better than in BM group (91.8%, 87.5%, 86.1% vs. 92.3%, 58.3%, 56.3%; HR 3.89, 95% CI 2.59–5.85, P < 0.0001). In subgroup analysis of WM group, the alpha-fetoprotein (AFP) (>400 ng/mL) was only significant risk factor for recurrence after LDLT (HR 2.95, 95% CI 1.23–7.07, P = 0.015). Regarding BM group, body mass index (<21.7kg/m2), platelet count, and AFP (>400 ng/mL) predicted recurrence at multivariable analysis ( P = 0.038, 0.0001, and < 0.0001, respectively).

Conclusions Milan criteria can predict the prognosis of patients after LDLT for HCC. The risk factors associated with recurrence of HCC may be different according to Milan criteria.

Keywords Hepatocellular carcinoma; Liver transplantation; Living-related liver donors; Recurrence

Liver transplantation center, National Cancer Center and Research Institute, Goyang, Korea.

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