Author information
1
Barcelona-Clínic Liver Cancer Group (BCLC), Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), CIBEREHD, Universitat de Barcelona, Barcelona, Catalonia, Spain.
2
Mount Sinai Liver Cancer Program, Icahn School of Medicine at Mount Sinai, New York, USA.
3
Institució Catalana de Recerca i Estudis Avançats, Barcelona, Catalonia, Spain.
4
Liver Transplant Unit, Digestive and Metabolic Diseases Institute. Hospital Clínic, University of Barcelona.
5
Pathology Department, Hospital Clínic, University of Barcelona.
6
Liver Unit, Digestive and Metabolic Diseases Institute. Hospital Clínic, University of Barcelona.
Abstract
BACKGROUND & AIMS:
A subset of patients with hepatocellular carcinoma (HCC) beyond Milan criteria might obtain acceptable survival outcomes after liver transplantation. Living donor liver transplantation (LDLT) has emerged as a feasible alternative to overcome the paucity of donors.
METHODS:
In 2001 we started a protocol for LDLT in Child A-B patients with HCC fulfilling a set of criteria - the BCLC expanded criteria- that expanded the conventional indications of transplantation: 1 tumor ≤ 7cm, 5 tumors ≤ 3cm, 3 tumors ≤ 5cm without macrovascular invasion or down-staging to Milan after loco-regional therapies.
RESULTS:
We present a prospective cohort of 22 patients with BCLC extended indications based on size/number (17) or down-staging (5) treated with LDLT between 2001 and 2014. Characteristics of the patients were as follows: median age: 57yr old; males/female: 20/2, Child-Pugh A/B: 16/6, AFP <100ng/mL: 21. Twelve patients received neo-adjuvant loco-regional therapies. At the time of transplantation, 12 patients had HCC staging beyond Milan criteria and 10 within. Pathological reports showed that 50% exceeded BCLC expanded criteria. Perioperative mortality was 0%. After a median follow up of 81 months, the 1-, 3-, 5- and 10-year survival was 95.5%, 86.4%, 80.2% and 66.8%, respectively. Overall, seven patients recurred (range 9-108 mo), and the 5-y and 10-yr actuarial recurrence rate was of 23.8% and 44,4%, respectively.
CONCLUSION:
A proper selection of candidates for extended indications of living donor liver transplantation for HCC patients provide survival outcomes comparable to those obtained within the Milan criteria, but these results needs confirmation.