Japanese living donor liver transplantation criteria for hepatocellular carcinoma: nationwide cohort study

Masahiro Ohira ^1,2, Gaku Aoki ³, Yasushi Orihashi ³

¹Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.
²Medical Centre for Translational and Clinical Research, Hiroshima University Hospital, Hiroshima, Japan.
³Department of Biostatistics, Clinical Research Centre in Hiroshima, Hiroshima University Hospital, Hiroshima, Japan.
⁴Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
⁵Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.
⁶Department of Surgery, Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
⁷Department of Paediatric Surgery and Transplantation, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan.
⁸Division of Artificial Organ and Transplantation, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
⁹Department of Gastroenterological Surgery, Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama University, Okayama, Japan.
¹⁰Division of Hepato-Biliary-Pancreatic and Transplantation Surgery, Japanese Red Cross Medical Centre, Tokyo, Japan.
¹¹Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
¹²Department of Organ Transplantation and General Surgery, Kyoto Prefectural University of Medicine, Kyoto, Japan.
¹³Department of Transplantation Surgery, Nagoya University Hospital, Nagoya, Japan.
¹⁴Department of Surgery, School of Medicine, Iwate Medical University, Yahaba, Japan.
¹⁵Department of Hepato-Biliary-Pancreatic Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
¹⁶Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.
¹⁷Department of Hepato-Biliary-Pancreatic and Breast Surgery, Graduate School of Medicine, Ehime University, Toon, Japan.
¹⁸Division of Gastroenterology, Department of Internal Medicine, Graduate School of Medicine, Kobe University, Kobe, Japan.
¹⁹Organ Transplantation Centre, National Centre for Child Health and Development, Tokyo, Japan.
²⁰Department of Digestive and Transplantation Surgery, Tokyo Medical University Hachioji Medical Centre, Tokyo, Japan.
²¹Division of Gastroenterological, Hepato-Biliary-Pancreatic, Transplantation, and Paediatric Surgery, Department of Surgery, Shinshu University, Matsumoto, Japan.
²²Department of Internal Medicine, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan.
²³Department of Gastroenterological, Breast, and Endocrine Surgery, Graduate School of Medicine, Yamaguchi University, Ube, Japan.
²⁴Department of Diagnostic Pathology, Kyoto University Hospital, Kyoto, Japan.
²⁵Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Graduate School of Medicine, Kobe University, Kobe, Japan.
²⁶Department of Gastroenterology and Hepatology, Faculty of Medicine, Saitama Medical University, Moroyama, Japan.
²⁷Department of Surgery, Osaka International Cancer Institute, Osaka, Japan.

⁰Department of Gastroenterological and Transplant Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan.

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August 2, 2024

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Summary

The Japanese criteria for liver transplants in hepatocellular carcinoma patients are valid, showing good survival rates. High neutrophil-to-lymphocyte ratio and prior hepatectomy indicate poor prognosis.

Area Of Science

Hepatobiliary Surgery
Transplant Oncology
Clinical Outcomes Research

Background

Living donor liver transplantation (LDLT) is crucial for hepatocellular carcinoma (HCC).
Expanded criteria for LDLT in HCC require validation using national data.
Evaluating new Japanese criteria for HCC patients undergoing LDLT is significant.

Purpose Of The Study

To assess the validity of the new Japanese criteria for LDLT in HCC patients.
To identify prognostic factors for poor outcomes in HCC patients undergoing LDLT.
To utilize Japanese national data for comprehensive analysis.

Main Methods

A nationwide survey of HCC patients undergoing LDLT between 2010-2018 at 37 Japanese centers.
Evaluation of overall survival and recurrence-free survival rates based on the Japanese 5-5-500 criteria.
Cox proportional hazards model used to determine prognostic factors within the Japanese criteria.

Main Results

Patients within Japanese criteria had 5-year OS of 81% and 5-year RFS of 77%.
Patients beyond Japanese criteria had 5-year OS of 58% and 5-year RFS of 48%.
Neutrophil-to-lymphocyte ratio ≥ 5 and prior hepatectomy were independent risk factors.

Conclusions

The Japanese criteria for LDLT in HCC are validated by this nationwide study.
Neutrophil-to-lymphocyte ratio ≥ 5 and prior hepatectomy are significant poor prognostic factors.
These findings support the use of expanded criteria for HCC liver transplantation.