Liberal selection criteria for liver transplantation for hepatocellular carcinoma

Authors: Muscari, F.; Foppa, B.; Kamar, N.; Peron, J. M.; Selves, J.; Suc, B.

Source: British Journal of Surgery, Volume 96, Number 7, July 2009 , pp. 785-791(7)

Publisher: John Wiley & Sons, Ltd.

Abstract:

Background:

To help increase the number of transplants available for hepatocellular carcinoma in cirrhotic livers, this single-centre retrospective study compared the safety and feasibility of new, more liberal, selection criteria—no more than five tumours, with the largest tumour no greater than 5 cm (5/5 criteria)—with classical criteria.

Methods:

Data from operations performed in 1990-2005 were extracted from preoperative radiological findings and postoperative specimen analyses, and four groups were constructed: Paul Brousse, Milan, University of California, San Francisco (UCSF) and 5/5 criteria. A fifth group comprised patients whose tumour load exceeded the 5/5 criteria. Survival and recurrence rates were compared.

Results:

For the 110 patients in the study, survival rates (overall and disease-free) were 72·8 and 66·8 per cent at 5 and 10 years respectively, with a 5·5 per cent recurrence rate. The 5-year survival rate was 65, 77, 68 and 77 per cent for Paul Brousse, Milan, UCSF and 5/5 preoperative radiological criteria, with recurrence rates of 4, 4, 3 and 3 per cent, respectively. On multivariable analysis, the only factor that influenced survival was tumour load in excess of the 5/5 criteria.

Conclusion:

Use of the more liberal 5/5 criteria for selecting patients for liver transplantation results in similar disease-free and overall survival rates to classical criteria. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.

Document Type: Research article

DOI: 10.1002/bjs.6619

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