Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
권호 표지

Expanded Criteria for Living Donor Liver Transplantation in Patients with Advanced Hepatocellular

진행성 간암환자에서 간이식 수술의 적응증 확대

  • Lee, Kyung-Keun (Department of Surgery, Catholic University of Korea) ;
  • Youn, Young-Chul (Department of Surgery, Catholic University of Korea) ;
  • Hwang, Jung-Ki (Department of Surgery, Catholic University of Korea) ;
  • Park, Jung-Hyun (Department of Surgery, Catholic University of Korea) ;
  • Kim, Ji-Il (Department of Surgery, Catholic University of Korea) ;
  • Yoo, Yung-Kyung (Department of Surgery, Catholic University of Korea) ;
  • Moon, In-Sung (Department of Surgery, Catholic University of Korea) ;
  • Kim, Dong-Goo (Department of Surgery, Catholic University of Korea)
  • 이경근 (가톨릭대학교 외과학교실) ;
  • 윤영철 (가톨릭대학교 외과학교실) ;
  • 황정기 (가톨릭대학교 외과학교실) ;
  • 박정현 (가톨릭대학교 외과학교실) ;
  • 김지일 (가톨릭대학교 외과학교실) ;
  • 유영경 (가톨릭대학교 외과학교실) ;
  • 문인성 (가톨릭대학교 외과학교실) ;
  • 김동구 (가톨릭대학교 외과학교실)
  • Published : 2009.09.30

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Abstract

Purpose: The purpose of this study was to evaluate the possibility of expanding the indication for living donor liver transplantation (LDLT) for treatment of hepatocellular carcinoma (HCC), beyond the Milan criteria without compromising patient survival. Methods: This was a retrospective study of 5patients (36.4%) that had undergone LDLT, beyond the Milan criteria, among 143 patients with HCC. The study was conducted in patients treated by the Department of Surgery, Catholic University of Korea from Oct 2000 to May 2008. We evaluated the survival curve, prognostic factors for survival and compared survival between our new criteria and Milan criteria. Results: The 5 year patient survival and disease free survival rate in patients treated with LDLT beyond the Milan criteria were 50.2% and 61.9%, respectively. The prognostic factors affecting disease free survival and patient survival included serum AFP level, tumor size, vascular invasion, and tumor cell differentiation on univariate analysis. In multivariate analysis, AFP (200 ng/mL), tumor size (7 cm) and vascular invasion had significant influence on survival and disease free survival. According to our new criteria (size <7 cm, AFP <200 ng/mL), 88.1% of our patients were included compare to the 63.6% that would have been if limited to the Milan criteria. With both factors met, the survival was comparable to the survival of Milan criteria (63.7% on our criteria and 78.2% on milan criteria at 5 years) (P=0.103). Conclusion: A tumor size <7 cm and an AFP < 200 ng/mL appear to be useful cut-off values, beyond that criteria required by Milan. An analysis according to our criteria showed an acceptable survival outcome. Further verification of these findings by a large volume or prospective study is required for widespread adoption of our new criteria.

Keywords

References

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