Living donor liver transplantation for hepatocellular carcinoma: the Japanese experience

Treatment strategies against hepatocellular carcinoma have progressed remarkably over the past decade. In Asia, evidence-based guidelines for the management of hepatocellular carcinoma have evolved, including the option of liver transplantation. Due to severe organ shortage, however, living donor liver transplantation has become mainstream in Japan. Unlike deceased donor transplantation, living donor transplantation is not limited by the restrictions imposed by the nationwide allocation system. The decision for transplantation often depends on institutional or case-by-case considerations, balancing the will of the donor, the operative risk, and the overall survival benefit for the recipient. Cumulative data from the national multicenter registry analysis as well as individual center experience suggest that expansion of the Milan criteria is warranted.