Living donor liver transplantation for Patients with beyond Milan hepatocellular carcinoma

Milan 기준을 넘는 간세포암에서 생체부분 간이식

  • Kim, Bong-Wan (Department of Surgery, Ajou University School of Medicine) ;
  • Bae, Byong-Ku (Department of Surgery, Ajou University School of Medicine) ;
  • Park, Yong-Keun (Department of Surgery, Ajou University School of Medicine) ;
  • Won, Jae-Hwan (Department of Intervention Radiology, Ajou University School of Medicine) ;
  • Bae, Jae-Ik (Department of Intervention Radiology, Ajou University School of Medicine) ;
  • Xu, Wei-Guang (Department of Surgery, Ajou University School of Medicine) ;
  • Wang, Hee-Jung (Department of Surgery, Ajou University School of Medicine) ;
  • Kim, Myung-Wook (Department of Surgery, Ajou University School of Medicine)
  • 김봉완 (아주대학교 의과대학 외과학교실) ;
  • 배병구 (아주대학교 의과대학 외과학교실) ;
  • 박용근 (아주대학교 의과대학 외과학교실) ;
  • 원재환 (아주대학교 의과대학 진단영상의학교실) ;
  • 배재익 (아주대학교 의과대학 진단영상의학교실) ;
  • 허위광 (아주대학교 의과대학 외과학교실) ;
  • 왕희정 (아주대학교 의과대학 외과학교실) ;
  • 김명욱 (아주대학교 의과대학 외과학교실)
  • Published : 2008.09.30

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 $18.8^{\circ}{\pm}8.8$ 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.

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