International Session(Symposium)1(JSH・JSGE・JSGCS)
Fri. November 3rd   14:30 - 17:00   Room 9: Portopia Hotel Main Building Kairaku 3
Unmet need among liver transplantation for HCC in the era of expanded criteria
Nobuhisa Akamatsu1, Akihiko Ichida1, Kiyoshi Hasegawa1
1Artificial Organ and Transplantation Division, Department of Surgery, The University of Tokyo
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.
Index Term 1: liver transplantation
Index Term 2: HCC
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