Introduction: Hepatocellular carcinoma(HCC) has high recurrence rate after liver resection(LR). The recurrence within Milan after LR is only 61- 79% in patient with child A. On the other hand, liver transplantation(LT) has better outcomes even in patient with child A than LR because LT can overcome the tumor and background liver factors. Therefore some authors insisted preemptive LT in patient with high probability of aggressive recurrence with some risk factors.we hypothesis that the according to the background liver and tumor biology, treatment option would be different.Method: We reviewed patient data retrospectively who received LR or LT in Seoul National university hospital. The patient group was divided into two groups according to the platelet count which reflect the degree of the cirrhosis. We performed risk factor analysis using only preoperative risk factors for decision. Platelet count and Child A were used as a background liver factor, and AFP and tumor size and number is used as tumor characteristics. Result: Total 663 patient was included in liver resection group and 210 patient was included in liver transplantation group. We compared overall survival(OS) and recurrence free survival(RFS) between LR group and LT group in each subgroups according to the degree of the cirrhosis. Three risk factors were used which was significant in multivariate analysis, AFP more than 100, the number of tumor is more than 1, the size of tumor is more than 5cm as a tumor factor. If there are no risk factors in no or mild cirrhosis group, RFS, OS was not significantly different in both group. And if there are one risk factors, OS was similar but RFS survival rate is higher in LT group. But if there are 2 risk factors, survival rate is higher in LT group. In second subgroup If there are no risk, overall survival was similar in both group. But if there are 1 risk factors, and 2 risk factors, survival rate is higher in LT group. Conclusion: If the patient with no or mild liver cirrhosis, LR can be performed even the patient have 1 risk factor. But when the patient with moderate to severe cirrhosis resection can be performed without any risk factor. LT have to be considered in patient with 2 risk factors even the mild cirrhotic liver. And If the patient with moderate to severe cirrhosis, even the 1 risk factors, transplantation have to be considered.

CITATION INFORMATION: Yoon K, Lee K.-W, Kim H, Oh D, Kim H.-S, Ahn S, Hong S, Yi N.-J, Suh K.-S. Which Way to Go, Liver Resection or Liver Transplantation for Hepatocellular Carcinoma in Child A Liver Cirrhosis. Am J Transplant. 2017;17 (suppl 3).

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