Liver Transplantation Criteria For Hepatocellular Carcinoma Should Be Expanded
Top Cited Papers
- 1 September 2007
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Annals of Surgery
- Vol. 246 (3), 502-511
- https://doi.org/10.1097/sla.0b013e318148c704
Abstract
Objective: To assess the efficacy of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) and the impact of current staging criteria on long term survival. Summary Background Data: HCC is becoming an increasingly common indication for OLT. Medicare approves OLT only for HCCs meeting the Milan criteria, thus limiting OLT for an expanding pool of potential liver recipients. We analyzed our experience with OLT for HCC to determine if expansion of criteria for OLT for HCC is warranted. Methods: All patients undergoing OLT for HCC from 1984 to 2006 were evaluated. Outcomes were compared for patients who met Milan criteria (single tumor ≤5 cm, maximum of 3 total tumors with none >3 cm), University of California, San Francisco (UCSF) criteria (single tumor 4.5 cm, and cumulative tumor size <8 cm), or exceeded UCSF criteria. Results: A total of 467 transplants were performed for HCC. At mean follow up of 6.6 ± 0.9 years, recurrence rate was 21.2%, and overall 1, 3, and 5-year survival was 82%, 65%, and 52%, respectively. Patients meeting Milan criteria had similar 5-year post-transplant survival to patients meeting UCSF criteria by preoperative imaging (79% vs. 64%; P = 0.061) and explant pathology (86% vs. 71%; P = 0.057). Survival for patients with tumors beyond UCSF criteria was significantly lower and was below 50% at 5 years. Multivariate analysis showed that tumor number (P < 0.001), lymphovascular invasion (P < 0.001), and poor differentiation (P = 0.002) independently predicted poor survival. Conclusions: This largest single institution experience with OLT for HCC demonstrates prolonged survival after liver transplantation for tumors beyond Milan criteria but within UCSF criteria, both when classified by preoperative imaging and by explant pathology. Measured expansion of OLT criteria is justified for tumors not exceeding the UCSF criteria.Keywords
This publication has 50 references indexed in Scilit:
- Analysis of Long-term Outcomes of 3200 Liver Transplantations Over Two DecadesAnnals of Surgery, 2005
- Living Donor Liver Transplantation for Adult Patients With Hepatocellular CarcinomaAnnals of Surgery, 2004
- Liver transplantation for hepatocellular carcinoma validation of present selection criteria in predicting outcomeLiver Transplantation, 2004
- Survival after liver transplantation in the United States: A disease-specific analysis of the UNOS databaseLiver Transplantation, 2004
- Recurrence of hepatocellular carcinoma after liver transplant: Patterns and prognosisLiver Transplantation, 2004
- The Barcelona approach: Diagnosis, staging, and treatment of hepatocellular carcinomaLiver Transplantation, 2004
- Liver Transplantation for the Treatment of Moderately or Well-Differentiated Hepatocellular CarcinomaAnnals of Surgery, 2004
- Liver transplantation for hepatocellular carcinoma: The MELD impactLiver Transplantation, 2004
- Hepatocellular carcinomaThe Lancet, 2003
- Can we expand the indications for liver transplantation among hepatocellular carcinoma patients with increased tumor size?Transplantation Proceedings, 2003