Introduction: Hepatocellular carcinoma (HCC) is the sixth most common cancer worldwide and the third highest cause of death related to malignancy. Since HCC diagnosis is typically late, the median survival following diagnosis is approximately 6-20 months. The 5-year survival rate is reported as less than 12%. HCC typically arises in the background of cirrhosis. Liver transplantation is regarded as an optimal radical therapy for selected patients with HCC. Initial experiences with orthotopic liver transplantation were limited to patients with extensive unresectable tumors, and were marked by uniformly dismal outcomes due to high rates of tumor recurrence. We aimed to evaluate our LT indications and results for HCC.

Materials and Methods: Between 8 December 1988 and 01 October 2016 we performed 545 liver transplants at our centers. Since 1994 we use our criteria for LT in HCC candidates at Baskent University and currently perform LT in all HCC patients without major vascular invasion and distant metastasis. We retrospectively reviewed our LT results of patients with HCC.

Results: 61 patients had liver transplantation for HCC. 52 were male and 9 were female. 31 of the patients were operated according to our expended criteria. 6 of these patients were children and 25 were adults. We had 16 patients (1 pediatric and 15 adult) who were beyond Milan criteria radiologically and pathologically. We had 15 patients (4 pediatric and 11 adults) who were within Milan criteria radiologically; but after LT, when pathologic specimens were evaluated, they were found to be beyond Milan. We had 1 patient incidentally diagnosed after transplantation who was beyond Milan criteria. Disease free 5-year survival rate of LT patients beyond Milan criteria was 56.8%.

Conclusions: Milan criteria can be safely and effectively expanded with promising results even in patients beyond Milan criteria. Recently interventional radiology has being applied before transplantation or resection.

CITATION INFORMATION: Haberal M, Akdur A, Moray G, Arslan G, Ozcay F, Selcuk H, Ozdemir H. Expanded Criteria for HCC in Liver Transplantation. Am J Transplant. 2017;17 (suppl 3).

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