| Theme |
Liver Transplantation -- Current Status and Perspective |
| Title |
Liver Transplantation for Hepatocellular Carcinoma |
| Author |
Kohei Ogawa |
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University |
| Author |
Toshimi Kaido |
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University |
| Author |
Shinji Uemoto |
Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University |
| [ Summary ] |
Liver transplantation (LT) is an ideal treatment for hepatocellular carcinoma (HCC), since it can cure both intrahepatic HCCs and underlying liver diseases. On the other hand, perioperative morbidity and mortality after LT are higher than those after other treatments for HCC including resection and ablation. Moreover, the prognosis for patients who recurred after LT is poor. Therefore, the selection criteria for LT for HCC patients to achieve low recurrence rates are important. Many centers in Japan and overseas have proposed expanded criteria for LT for HCC beyond the Milan criteria (single tumor ≤5 cm in diameter or with ≤3 tumors all ≤3 cm in diameter). We have proposed a new expanded selection criteria (Kyoto criteria : tumor number ≤10, the maximal diameter of each tumor ≤5 cm and protein induced by vitamin K absence or antagonist-II levels of ≤400 mAU/ml), and have reported that favorable long-term outcomes can be obtained for patients who meet the Kyoto criteria. At present, patients demonstrating uncontrolled recurrent HCC undergo LT as a second-line treatment after previous treatments. The role of LT in the treatment of HCC will change with increases in the number of diseased donor LT. |