Multicenter Study

. 2024 Jul 2;8(4):zrae079.

doi: 10.1093/bjsopen/zrae079.

Japanese living donor liver transplantation criteria for hepatocellular carcinoma: nationwide cohort study

Masahiro Ohira^{1

2}, Gaku Aoki³, Yasushi Orihashi³, Kenichi Yoshimura², Takeo Toshima⁴, Etsuro Hatano⁵, Susumu Eguchi⁶, Taizo Hibi⁷, Kiyoshi Hasegawa⁸, Yuzo Umeda⁹, Takuya Hashimoto¹⁰, Yasushi Hasegawa¹¹, Shuji Nobori¹², Yasuhiro Ogura¹³, Hiroyuki Nitta¹⁴, Hiroto Egawa¹⁵, Hidetoshi Eguchi¹⁶, Yasutsugu Takada¹⁷, Yoshihide Ueda¹⁸, Mureo Kasahara¹⁹, Shigeyuki Kawachi²⁰, Yuji Soejima²¹, Katsutoshi Tokushige²², Hiroaki Nagano²³, Hironori Haga²⁴, Takumi Fukumoto²⁵, Satoshi Mochida²⁶, Koji Umeshita²⁷, Hideki Ohdan¹; Japanese Liver Transplantation Society

Collaborators, Affiliations

Collaborators

Affiliations

¹ Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
² Medical Centre for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
³ Department of Biostatistics, Clinical Research Centre in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan.
⁴ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁵ Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁶ Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
⁷ Department of Paediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
⁸ Division of Artificial Organ and Transplantation, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁹ Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
¹⁰ Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Japanese Red Cross Medical Centre, Tokyo, Japan.
¹¹ Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
¹² Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹³ Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan.
¹⁴ Department of Surgery, School of Medicine, Iwate Medical University, Yahaba, Japan.
¹⁵ Department of Hepato-Biliary-Pancreatic Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
¹⁶ Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹⁷ Department of Hepato-Biliary-Pancreatic and Breast Surgery, Graduate School of Medicine, Ehime University, Toon, Japan.
¹⁸ Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
¹⁹ Organ Transplantation Centre, National Centre for Child Health and Development, Tokyo, Japan.
²⁰ Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Centre, Tokyo, Japan.
²¹ Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Paediatric Surgery, Department of Surgery, Shinshu University, Matsumoto, Japan.
²² Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
²³ Department of Gastroenterological, Breast, and Endocrine Surgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
²⁴ Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
²⁵ Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
²⁶ Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Moroyama, Japan.
²⁷ Department of Surgery, Osaka International Cancer Institute, Osaka, Japan.

PMID: 39092977
PMCID: PMC11295212
DOI: 10.1093/bjsopen/zrae079

Multicenter Study

Japanese living donor liver transplantation criteria for hepatocellular carcinoma: nationwide cohort study

Masahiro Ohira et al. BJS Open. 2024.

. 2024 Jul 2;8(4):zrae079.

doi: 10.1093/bjsopen/zrae079.

Authors

Collaborators

Affiliations

¹ Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
² Medical Centre for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
³ Department of Biostatistics, Clinical Research Centre in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan.
⁴ Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁵ Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁶ Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
⁷ Department of Paediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
⁸ Division of Artificial Organ and Transplantation, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁹ Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
¹⁰ Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Japanese Red Cross Medical Centre, Tokyo, Japan.
¹¹ Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
¹² Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹³ Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan.
¹⁴ Department of Surgery, School of Medicine, Iwate Medical University, Yahaba, Japan.
¹⁵ Department of Hepato-Biliary-Pancreatic Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
¹⁶ Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹⁷ Department of Hepato-Biliary-Pancreatic and Breast Surgery, Graduate School of Medicine, Ehime University, Toon, Japan.
¹⁸ Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
¹⁹ Organ Transplantation Centre, National Centre for Child Health and Development, Tokyo, Japan.
²⁰ Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Centre, Tokyo, Japan.
²¹ Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Paediatric Surgery, Department of Surgery, Shinshu University, Matsumoto, Japan.
²² Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
²³ Department of Gastroenterological, Breast, and Endocrine Surgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
²⁴ Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
²⁵ Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
²⁶ Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Moroyama, Japan.
²⁷ Department of Surgery, Osaka International Cancer Institute, Osaka, Japan.

PMID: 39092977
PMCID: PMC11295212
DOI: 10.1093/bjsopen/zrae079

Abstract

Background: Validating the expanded criteria for living donor liver transplantation for hepatocellular carcinoma using national data is highly significant. The aim of this study was to evaluate the validity of the new Japanese criteria for living donor liver transplantation for hepatocellular carcinoma patients and identify factors associated with a poor prognosis using the Japanese national data set.

Methods: The study population comprised patients who underwent living donor liver transplantation for hepatocellular carcinoma at 37 centres in Japan between 2010 and 2018. In a nationwide survey, the overall survival and recurrence-free survival rates were evaluated based on the new Japanese criteria for applying the 5-5-500 rule when extending the indication beyond the Milan criteria. Prognostic factors within the Japanese criteria were determined using the Cox proportional hazards model.

Results: Patients within (485 patients) and beyond (31 patients) the Japanese criteria exhibited 5-year overall survival rates of 81% and 58% and 5-year recurrence-free survival rates of 77% and 48% respectively. Patients who met the Milan criteria, but not the 5-5-500 rule, had poorer outcomes. Multivariate analysis for 474 patients identified a neutrophil-to-lymphocyte ratio greater than or equal to 5 and a history of hepatectomy as independent risk factors.

Conclusion: This nationwide survey confirms the validity of the Japanese criteria. The poor prognostic factors within the Japanese criteria include a neutrophil-to-lymphocyte ratio greater than or equal to 5 and previous hepatectomy.

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Figures

**Fig. 1**
Study flow chart HCC, hepatocellular carcinoma; LT, liver transplantation; DDLT, deceased donor liver transplantation; AFP, α-fetoprotein; NLR, neutrophil-to-lymphocyte ratio; DM, diabetes mellitus.

**Fig. 2**
Survival of patients undergoing liver transplantation for hepatocellular carcinoma stratified by the Japanese criteria a Overall survival. b Recurrence-free survival. LT, liver transplantation.

**Fig. 3**
Survival of patients undergoing liver transplantation for hepatocellular carcinoma stratified by the Milan criteria and the 5-5-500 rule a Overall survival. b Recurrence-free survival. LT, liver transplantation.

See this image and copyright information in PMC

References

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1. Shimamura T, Akamatsu N, Fujiyoshi M, Kawaguchi A, Morita S, Kawasaki S et al. Expanded living-donor liver transplantation criteria for patients with hepatocellular carcinoma based on the Japanese nationwide survey: the 5-5-500 rule—a retrospective study. Transpl Int 2019;32:356–368 - PubMed
1. Sugawara Y, Tamura S, Makuuchi M. Living donor liver transplantation for hepatocellular carcinoma: Tokyo University series. Dig Dis 2007;25:310–312 - PubMed
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Japanese living donor liver transplantation criteria for hepatocellular carcinoma: nationwide cohort study

Collaborators

Affiliations

Japanese living donor liver transplantation criteria for hepatocellular carcinoma: nationwide cohort study

Authors

Collaborators

Affiliations

Abstract

Figures

References

Publication types

MeSH terms

Grants and funding

LinkOut - more resources

Full Text Sources

Medical

Miscellaneous