Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy
Purpose: This study was designed to elucidate the various new classifications and the use of LDLT and bridging therapy for HCC in this context beyond the Milan criteria (MC). Methods: The clinical data of patients with HCC outside the MC who underwent LT at Jena University between January 2007 and A...
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| Format: | Article |
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MDPI AG
2024-02-01
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| Series: | Cancers |
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| Online Access: | https://www.mdpi.com/2072-6694/16/5/920 |
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| author | Oliver Rohland Lea Freye Laura Schwenk Aladdin Ali-Deeb Michael Ardelt Astrid Bauschke Utz Settmacher Falk Rauchfuß Felix Dondorf |
| author_facet | Oliver Rohland Lea Freye Laura Schwenk Aladdin Ali-Deeb Michael Ardelt Astrid Bauschke Utz Settmacher Falk Rauchfuß Felix Dondorf |
| author_sort | Oliver Rohland |
| collection | DOAJ |
| description | Purpose: This study was designed to elucidate the various new classifications and the use of LDLT and bridging therapy for HCC in this context beyond the Milan criteria (MC). Methods: The clinical data of patients with HCC outside the MC who underwent LT at Jena University between January 2007 and August 2023 were retrospectively analysed. Eligible patients were classified according to various classification systems. Clinicopathological features, overall and disease-free survival rates were compared between LT and LDLT within the context of bridging therapy. The Results: Among the 245 patients analysed, 120 patients did not meet the MC, and 125 patients met the MC. Moreover, there were comparable overall survival rates between patients outside the MC for LT versus LDLT (OS 44.3 months vs. 28.3 months; 5-year survival, 56.4% vs. 40%; <i>p</i> = 0.84). G3 tumour differentiation, the presence of angioinvasion and lack of bridging were statistically significant risk factors for tumour recurrence according to univariate and multivariate analyses (HR 6.34; <i>p</i> = 0.0002; HR 8.21; <i>p</i> < 0.0001; HR 7.50; <i>p</i> = 0.0001). Bridging therapy before transplantation provided a significant survival advantage regardless of the transplant procedure (OS: <i>p</i> = 0.008; DFS: <i>p</i> < 0.001). Conclusions: Patients with HCC outside the MC who underwent LT or LDLT had worse outcomes compared to those of patients who met the MC but still had a survival advantage compared to patients without transplantation. Nevertheless, such patients remain disadvantaged on the waiting list, which is why LDLT represents a safe alternative to LT and should be considered in bridged HCC patients because of differences in tumour differentiation, size and tumour marker dynamics. |
| first_indexed | 2024-04-25T00:33:03Z |
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| issn | 2072-6694 |
| language | English |
| last_indexed | 2024-04-25T00:33:03Z |
| publishDate | 2024-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Cancers |
| spelling | doaj.art-1ff1d77ed30f493e8b07b147ec7125822024-03-12T16:40:51ZengMDPI AGCancers2072-66942024-02-0116592010.3390/cancers16050920Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant TherapyOliver Rohland0Lea Freye1Laura Schwenk2Aladdin Ali-Deeb3Michael Ardelt4Astrid Bauschke5Utz Settmacher6Falk Rauchfuß7Felix Dondorf8Department of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, GermanyDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, GermanyDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, GermanyDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, GermanyDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, GermanyDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, GermanyDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, GermanyDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, GermanyDepartment of General, Visceral and Vascular Surgery, Jena University Hospital, 07747 Jena, GermanyPurpose: This study was designed to elucidate the various new classifications and the use of LDLT and bridging therapy for HCC in this context beyond the Milan criteria (MC). Methods: The clinical data of patients with HCC outside the MC who underwent LT at Jena University between January 2007 and August 2023 were retrospectively analysed. Eligible patients were classified according to various classification systems. Clinicopathological features, overall and disease-free survival rates were compared between LT and LDLT within the context of bridging therapy. The Results: Among the 245 patients analysed, 120 patients did not meet the MC, and 125 patients met the MC. Moreover, there were comparable overall survival rates between patients outside the MC for LT versus LDLT (OS 44.3 months vs. 28.3 months; 5-year survival, 56.4% vs. 40%; <i>p</i> = 0.84). G3 tumour differentiation, the presence of angioinvasion and lack of bridging were statistically significant risk factors for tumour recurrence according to univariate and multivariate analyses (HR 6.34; <i>p</i> = 0.0002; HR 8.21; <i>p</i> < 0.0001; HR 7.50; <i>p</i> = 0.0001). Bridging therapy before transplantation provided a significant survival advantage regardless of the transplant procedure (OS: <i>p</i> = 0.008; DFS: <i>p</i> < 0.001). Conclusions: Patients with HCC outside the MC who underwent LT or LDLT had worse outcomes compared to those of patients who met the MC but still had a survival advantage compared to patients without transplantation. Nevertheless, such patients remain disadvantaged on the waiting list, which is why LDLT represents a safe alternative to LT and should be considered in bridged HCC patients because of differences in tumour differentiation, size and tumour marker dynamics.https://www.mdpi.com/2072-6694/16/5/920hepatocellular carcinomaMilan criterialiving donor liver transplantationtransplant outcome |
| spellingShingle | Oliver Rohland Lea Freye Laura Schwenk Aladdin Ali-Deeb Michael Ardelt Astrid Bauschke Utz Settmacher Falk Rauchfuß Felix Dondorf Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy Cancers hepatocellular carcinoma Milan criteria living donor liver transplantation transplant outcome |
| title | Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy |
| title_full | Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy |
| title_fullStr | Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy |
| title_full_unstemmed | Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy |
| title_short | Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy |
| title_sort | liver transplantation for hepatocellular carcinoma beyond the milan criteria a specific role for living donor liver transplantation after neoadjuvant therapy |
| topic | hepatocellular carcinoma Milan criteria living donor liver transplantation transplant outcome |
| url | https://www.mdpi.com/2072-6694/16/5/920 |
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