Living donor liver transplantation for hepatocellular carcinoma: To expand (beyond Milan) or downstage (to Milan)?

Living donor liver transplantation for hepatocellular carcinoma: To expand (beyond Milan) or... AbbreviationsAFPalpha‐fetoproteinBCLCBarcelona Clinic Liver CancerDCPdes‐gamma‐carboxyprothrombinHCChepatocellular carcinomaLDLTliving donor liver transplantationLRTlocal‐regional therapyLTliver transplantationFor patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria, survival after liver transplantation (LT) incrementally decreases with increasing tumor size and number. The allocation system for deceased donors in the United States is largely restricted to HCC within Milan criteria and does not accommodate to even modest expansion of tumor size. Wait‐list dropout rates remain substantial even for HCC within Milan criteria in long wait‐time regions. Living donor liver transplantation (LDLT) has been performed for patients with HCC beyond Milan criteria adhering to the principle that the risk to the donor is justified by the expectation of an acceptable outcome for the recipient (double equipoise). However, the boundaries of tumor size and number to be considered for LDLT have varied widely among centers without a consensus based on reproducible data. Furthermore, the minimal acceptable survival threshold after LDLT has not been well defined.In this issue of Liver Transplantation, Llovet et al. from the Barcelona Clinic Liver Cancer (BCLC) group report their longterm results up to 10 years following LDLT for HCC beyond Milan criteria in a prospectively applied protocol. The study cohort met the proposed BCLC extended criteria (1 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Liver Transplantation Wiley

Living donor liver transplantation for hepatocellular carcinoma: To expand (beyond Milan) or downstage (to Milan)?

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Publisher
Wiley Subscription Services, Inc., A Wiley Company
Copyright
© 2018 by the American Association for the Study of Liver Diseases.
ISSN
1527-6465
eISSN
1527-6473
D.O.I.
10.1002/lt.25017
Publisher site
See Article on Publisher Site

Abstract

AbbreviationsAFPalpha‐fetoproteinBCLCBarcelona Clinic Liver CancerDCPdes‐gamma‐carboxyprothrombinHCChepatocellular carcinomaLDLTliving donor liver transplantationLRTlocal‐regional therapyLTliver transplantationFor patients with hepatocellular carcinoma (HCC) exceeding the Milan criteria, survival after liver transplantation (LT) incrementally decreases with increasing tumor size and number. The allocation system for deceased donors in the United States is largely restricted to HCC within Milan criteria and does not accommodate to even modest expansion of tumor size. Wait‐list dropout rates remain substantial even for HCC within Milan criteria in long wait‐time regions. Living donor liver transplantation (LDLT) has been performed for patients with HCC beyond Milan criteria adhering to the principle that the risk to the donor is justified by the expectation of an acceptable outcome for the recipient (double equipoise). However, the boundaries of tumor size and number to be considered for LDLT have varied widely among centers without a consensus based on reproducible data. Furthermore, the minimal acceptable survival threshold after LDLT has not been well defined.In this issue of Liver Transplantation, Llovet et al. from the Barcelona Clinic Liver Cancer (BCLC) group report their longterm results up to 10 years following LDLT for HCC beyond Milan criteria in a prospectively applied protocol. The study cohort met the proposed BCLC extended criteria (1

Journal

Liver TransplantationWiley

Published: Jan 1, 2018

References

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