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Living donor liver transplantation for Patients with beyond Milan hepatocellular carcinoma

Other Title
Milan 기준을 넘는 간세포암에서 생체부분 간이식
Authors
김, 봉완; 배, 병구; 박, 용근; 원, 재환; 배, 재익; 허, 위광; 왕, 희정; 김, 명욱
Citation
Korean journal of hepato-biliary-pancreatic surgery, 12(3):162-167, 2008
Journal Title
Korean journal of hepato-biliary-pancreatic surgery
ISSN
1738-63492288-9213
Abstract
Background: To find the patients who have a significant chance of cure with living donor liver transplantation (LDLT) among the patients suffering with beyond-Milan hepatocellular carcinoma (HCC), we retrospectively analyzed the tumor factors that could affect a good prognosis after LDLT for patients who suffer with beyond Milan HCC.



Methods: Between March 2005 and May 2007, 18 cases of LDLT for beyond Milan HCC were performed. None of the patients had preoperative radiological evidence of vascular invasion. Excluding the 3 cases of in-hospital mortality, we analyzed the survival, the disease-free survival and the prognostic factors for recurrence in 15 beyond Milan HCC patients. The mean follow-up period was 18.8 °± 8.8 months (range: 4-34 months).



Results: The two-year survival and disease-free survival rates after LDLT were 61.7% and 31.1%, respectively, in 15 beyond-Milan patients. Among them, 9 patients had recurrence of HCC during follow-up. The one-year survival rate after tumor recurrence was 55.5%. An alphafetoprotein (AFP) level < 400 ng/mL, Edmonson-Steiner histology grade I and II and the presence of graft rejection were analyzed as the good prognostic factors of disease-free survival after LDLT for beyond-Milan HCC (p < .05). The patients with negative preoperative positron emission tomography (PET) findings (n = 5) showed a better prognosis than the PET-positive patients (n = 10) with statistical significance (p = .05).



Conclusion: Allowing that HCC patients exceed the Milan criteria, we can find the potentially curable candidates for LDLT with using tumor biologic markers such as a serum AFP level < 400 ng/mL, negative PET uptake or low grade histology, as assessed by preoperative needle biopsy. Further investigation is needed to evaluate the relation between graft rejection and tumor recurrence after liver transplantation.
Keywords
간세포암생체부분 간이식Liver transplantationLiving DonorsMilan criteriaHCCHepatocellular carcinoma
Appears in Collections:
Journal Papers > School of Medicine / Graduate School of Medicine > Radiology
Journal Papers > School of Medicine / Graduate School of Medicine > Surgery
AJOU Authors
김, 봉완배, 병구원, 제환배, 재익왕, 희정김, 명욱
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