| [ Summary ] |
Liver transplantation (LT) plays a significant clinical role in the treatment of hepatocellular carcinoma (HCC), since it can cure not only HCC but also underlying liver diseases. Although various transplant criteria for HCC have been proposed, expanding the criteria remains an area of controversy. Extended criteria can be justified when the results exhibit acceptably low recurrence rates. We performed retrospective analysis of 136 HCC patients who underwent living donor LT (LDLT) in our center between February 1999 and December 2006 to examine the risk factors for post transplant recurrence. Based on the results of multivariate analysis, we defined the new criteria (Kyoto criteria) as being n≤10, all≤5cm in diameter, and serum des-gamma-carboxy prothrombin levels of≤400 mAU/ml. The 5-year recurrence rate for patients who met the Kyoto criteria was significantly lower than that for patients who exceeded these criteria(5% vs. 58%, p<0.0001). The Kyoto criteria can thus effectively exclude patients with biologically aggressive tumors before transplantation. We have implemented the Kyoto criteria since January 2007 and have started a prospective study to validate their feasibility. As of August 2009, 36 patients with HCC underwent LDLT. The 1- and 2-year recurrence rates were 4％. Taking into consideration the higher morbidity and mortality associated with LT compared to other treatment modalities for HCC as well as risks to live donors, however, it would be appropriate that LDLT be held in reserve as a second-line treatment option for HCC. |