| Expanded indication criteria for HCC in liver transplantation has long been debated. Recently, we proposed the 5-5-500 criteria (within 5 nodules, within 5cm, AFP less than 500ng/ml), and now the Japanese double eligibility criteria (patients meeting the Milan or the 5-5-500 criteria) has been approved as an official indication criterion in Japan. Among 190 HCC recipients who underwent liver transplantation in our center, the overall recurrence rate was 8.9% (17/190), with 5-year survival rate and recurrence rate of 82% and 11%, respectively. The 5-year recurrence rate according to each indication criteria, 6.9% with Milan, 6.5% with 5-5-500, 8.2% with Tokyo, and 8.2% with Japan. Since the Japan criteria, 8 out of 30 patients (27%) were beyond Milan but within Japan. HCC patients (n=325) who underwent liver resection for primary HCC within Milan at our center were compared with our LDLT cohort. Overall survival (1, 3, 5, 10-year survival; 95%, 83%, 69%, 49%) was significantly worse when compared to LDLT recipients. Child B patients (n=32) showed significantly worse survival. Overall survival of Child A (ICG-R15 less than 20%) after resection was worse than that of LDLT group without significance, however, Child A (ICG-R15 20% and more) achieved significantly better 5-year survival. These results indicate that Child B HCC patients and selected Child A HCC patients should be indicated for liver transplantation. |
