Prognostic importance of the gross classification of hepatocellular carcinoma in living donor-related liver transplantation

Background: The gross classification of hepatocellular carcinoma (HCC) has been reported to be a significant prognostic factor for patients with HCC undergoing partial hepatectomy. The present study investigated whether the gross classification of HCC is also a prognostic factor in living donor-related liver transplantation (LDLT). Methods: Some 119 patients undergoing LDLT for HCC were identified retrospectively from a prospective institutional database containing information on all LDLTs carried out between 1996 and 2009. Patients were divided into three groups according to the gross classification of the largest tumour in the explanted liver: type 1 HCC, single nodular type (81 patients); type 2, single nodular type with extranodular growth (21); and type 3, contiguous multinodular type (17). Clinicopathological factors and recurrence-free survival rates were compared. Results: Recurrence-free survival rates for the whole group were 87.7 per cent at 1 year, 83.5 per cent at 3 years and 81.0 per cent at 5 years after LDLT. Type 3 HCC was associated with large tumour size, poor histological grade, a high incidence of microvascular invasion and multiple tumours. Independent predictors of poor recurrence-free survival were preoperative serum level of des-gamma-carboxy prothrombin exceeding 300 mAU/ml, microvascular invasion and type 3 HCC. Conclusion: The gross classification of HCC was an independent predictor for recurrence of HCC in patients undergoing LDLT.