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. 2016 Jan;18(1):98-106.
doi: 10.1016/j.hpb.2015.08.008. Epub 2015 Dec 9.

Effects of loco regional treatments before living donor liver transplantation on overall survival and recurrence-free survival in South Korean patients with hepatocellular carcinoma

Gun H Na  1 , Eun Y Kim  1 , Tae H Hong  1 , Young K You  1 , Dong G Kim  2
Affiliations

Effects of loco regional treatments before living donor liver transplantation on overall survival and recurrence-free survival in South Korean patients with hepatocellular carcinoma

Gun H Na et al. HPB (Oxford). 2016 Jan.

Abstract

Background: We evaluated the effects of pre-transplant locoregional treatment on survival in living donor liver transplantation (LDLT), and the most accurate method for predicting survival after LDLT in patients who received pre-transplant locoregional treatment.

Methods: From December 2003 to December 2012, 234 patients underwent LDLT for hepatocellular carcinoma (HCC) at our transplant center. We retrospectively reviewed 86 patients newly diagnosed with HCC and who received pre-transplant locoregional treatments at our hospital.

Results: Of the 33 patients with HCC initially beyond the Milan criteria, 12 experienced successful down-staging after locoregional treatments, and the 5-year recurrence-free survival was 81.8%, which was comparable to those in patients with HCC initially within the Milan criteria. A bad responder according to the modified Response Evaluation Criteria in Solid Tumors (mRECIST) [HR, 4.874 (1.059-22.442), p = 0.042], and increased AFP levels [HR 4.002 (1.540-10.397), p = 0.004] during pre-transplant locoregional treatments were independent risk factors for HCC recurrence after LDLT in multivariate analysis.

Conclusions: Liver transplantation may be considered after successful down-staging in patients with HCC initially beyond the Milan criteria. The mRECIST and serum AFP level changes are better selection criteria for LDLT in patients who have received locoregional treatments.

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Figures

Figure 1
Figure 1
Recurrence-free survival (a) and overall survival (b) following Milan criteria changes after locoregional treatments
Figure 2
Figure 2
Recurrence-free survival and overall survival according to the various methods used to assess tumor response after locoregional treatments. Milan criteria at HCC diagnosis (a), Milan criteria at transplantation (b), the mRECIST criteria (c), the change of AFP (d), the change of PIVKA-II (e), and tumor necrosis (f). AFP, Alpha-fetoprotein; mRECIST, modified Response Evaluation Criteria in Solid Tumors; PIVKA-II, proteins induced by vitamin K antagonism or absence-II
Figure 2
Figure 2
Recurrence-free survival and overall survival according to the various methods used to assess tumor response after locoregional treatments. Milan criteria at HCC diagnosis (a), Milan criteria at transplantation (b), the mRECIST criteria (c), the change of AFP (d), the change of PIVKA-II (e), and tumor necrosis (f). AFP, Alpha-fetoprotein; mRECIST, modified Response Evaluation Criteria in Solid Tumors; PIVKA-II, proteins induced by vitamin K antagonism or absence-II
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