Comparative evaluation of expanded criteria for patients with hepatocellular carcinoma beyond the Milan criteria undergoing living-related donor liver transplantation

Objective: To clarify the predictive impact of expanded criteria for liver transplantation (LT) for patients with hepatocellular carcinoma (HCC) in 54 patients with HCC beyond the Milan criteria (MC) from a series of 109 consecutive living-related donor liver transplantation (LDLT) recipients with HCC. Methods: Among 54 patients with HCC exceeding the MC, the predictive values for HCC recurrence within expanded criteria comprising the UCSF, Tokyo, Kyoto, Kyushu University (based on the tumor size and des-gamma carboxy prothrombin level) and Up-to-seven criteria were compared using univariate and multivariate analyses. The histological characteristics of HCC were compared among these extended criteria. Results: All five criteria were significant predictors for recurrence-free survival after univariate analyses. The Kyushu University criteria were the most powerful predictive criteria for HCC recurrence after multivariate analyses. The incidence of microvascular invasion and poorly differentiated HCC was significantly higher in patients with HCC exceeding the Kyushu University criteria than in those with HCC within the criteria. Conclusions: Compared with the other expanded criteria, the Kyushu University criteria may be useful to eliminate LT candidates at very high risk of HCC recurrence. The Kyushu University criteria were useful to evaluate LT candidates with HCC.