Current Status in Indication of Deceased and Living Donor Liver Transplantation for Hepatocellular Carcinoma in 22 Liver Transplant Centers in the World

Susumu Eguchi, Mitsuhisa Takatsuki, Akihiko Soyama, Masaaki Hidaka, Hirotaka Tokai, Koji Hamasaki, Kensuke Miyazaki, Yoshitsugu Tajima and Takashi Kanematsu

Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences

We clarified the differences in indications of liver transplantation (LT) for hepatocellular carcinoma (HCC) outside Japan, sending 3 queries to 22 LT centers: (1) What is an indication of LT for HCC at your center? (2) Is the indication for HCC different between deceased donor (DD) LT and living donor (LD) LT? (3) If so, how and why? The indication of DDLT for HCC was Milano criteria (M-C) in 2/4 (50%) and UCSF criteria (UCSF-C) in 2/4 in Asia (50%). In Australia and Europe, M-C was 12/13 (92%). In the USA, 2/5 used M-C (40%), while 3/5 used UCSF-C (60%) but only with a marginal graft, e.g., fatty liver graft. The indication of LDLT for HCC in Asia was still 2/4 (50%) with M-C and 2/4 with UCSF-C (50%). In Europe, 9/12 centers stay with M-C (66%). In the USA, 3/5 centers do not conduct LDLT for HCC, since they use marginal DD liver for patients beyond M-C. One center conducts LDLT only for HCC beyond M-C. Asia produced more opinions to expand LT indications for HCC. In Europe and Australia, an indication of LT for HCC tends to be strict with M-C even for LDLT. In the USA, because of their own allocation system, DD liver is rather easily available for patients within M-C or UCSF-C. Patients beyond M-C tend to be transplanted with marginal grafts or undergo LDLT.

Key words
hepatocellular carcinoma, indication, liver transplantation

Reprint requests
Susumu Eguchi Department of Surgery, Nagasaki University Graduate School of Biomedical Sciences
1-7-1 Sakamoto, Nagasaki, 852-8501 JAPAN

Accepted
October 25, 2006

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