[Significance of liver transplantation for hepatocellular carcinoma]

Liver transplantation(LT)plays a significant clinical role in the treatment of hepatocellular carcinoma(HCC), as it can cure not only HCC but also underlying liver diseases. Although various transplant criteria for HCC have been proposed, expanding the criteria is controversial. Extended criteria are justified when the recurrence rates are low. We performed retrospective analysis of 136 HCC patients who underwent living donor LT(LDLT)at our center between February 1999 and December 2006 to examine the risk factors for post-transplant recurrence. Based on the results of our multivariate analysis, we defined new criteria, which we call the Kyoto criteria. The new criteria are as follows: nC10, tumor diameter C5 cm, and serum desgamma- carboxy prothrombin levels of C400mAU/mL. The 5-year recurrence rate for patients who met the Kyoto criteria was significantly lower than that for patients who exceeded these criteria(3% vs 56%, p<0.001). This demonstrates that the Kyoto criteria can effectively exclude patients with biologically aggressive tumors prior to transplantation. We began to implement the Kyoto criteria in January 2007 and have started a prospective study to validate the feasibility of these criteria. As of December 2011, 62 patients with HCC have undergone LDLT. These patients had a 5-year overall survival rate of 82%, and a recurrence rate of 6%. Considering the higher morbidity and mortality rates associated with LT compared to those for other treatment modalities for HCC as well as risks to live donors, LDLT is better used as a second-line treatment option for HCC.