Adoption of new selection criteria on living donor liver transplantation for hepatocellular carcinoma and their impact on the outcome

Background/Aims: In cadaveric liver transplantation, the Milan criteria have been accepted as the selection criteria for HCC in considering organ allocation. However, the situation in LDLT is different. Methodology: This is a retrospective study on 518 recipients who underwent LDLT. The exclusion criteria included HCC with extrahepatic spread and HCC extending to the major hepatic vessels detected during the preoperative evaluation. Results: HCC was the indication in 96 patients (18.5%); 52/96 patients (54.2%) fulfilled Milan criteria and 44/96 patients (45.8%) did not. The 5-year survival rate among patients fulfilling Milan criteria was 40/52 (77.0%) while for those who did not 30/44 (68.0%). Although these results show better survival rates among patients with HCC within the Milan criteria, they are insignificant (p=0.01) and they clearly demonstrate that patients with HCC outside the Milan criteria have nearly the same survival rate as patients with HCC within Milan criteria. Conclusions: Transplantation is the best treatment option for patients with HCC if a careful search reveals no extra-hepatic disease. The application of the Milan criteria for all patients with HCC would have denied many patients who can survive after transplantation. In LDLT programs, where the patient has a special living donor, the Milan criteria are not necessarily relevant © H.G.E. Update Medical Publishing S.A.