Living donor liver transplantation for recurrent hepatocellular carcinoma after liver resection.

BACKGROUND: Little is known about outcomes and indications for living donor liver transplantation in patients with recurrent hepatocellular carcinoma after liver resection.

METHODS: We analyzed retrospectively 176 patients with hepatocellular carcinoma who underwent living donor liver transplantation at our institute between February 1999 and December 2009. Among 128 of 176 patients with a history of pretreatment for hepatocellular carcinoma, 19 patients underwent radical liver resection. We compared patient characteristics, intraoperative blood loss, operative duration, and long-term outcomes including overall survival and recurrence rates between patients who had received hepatectomy, other pretreatments, and no pretreatments.

RESULTS: The surgical duration was significantly longer in patients with pretransplant hepatectomy than in those who had undergone other types of pretreatment (n = 109) or none (n = 48), whereas intraoperative blood loss did not differ among the 3 groups. Overall survival and recurrence rates did not significantly differ among the 3 groups. In patients with pretransplant hepatectomy, survival rates were significantly higher among patients who met the Kyoto criteria (≤10 tumors, all ≤5 cm in diameter and serum des-gamma-carboxy prothrombin levels ≤400 mAU/mL; n = 15) than those with values that exceeded the Kyoto criteria (n = 4) (5-year survival rates, 93% vs 25%, P = .005). Similarly, recurrence rates were significantly lower among patients meeting than exceeding the Kyoto criteria (5-year recurrence rates, 10% vs 67%, P = .011).

CONCLUSION: Patients with hepatocellular carcinoma recurrence after liver resection can safely undergo living donor liver transplantation. Long-term outcomes can be particularly favorable in patients who meet the Kyoto criteria.