Do We Need to Be Limited by Matching Milan Criteria for Survival in Living Donor Liver Transplantation?
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REVIEW ARTICLE
Do We Need to Be Limited by Matching Milan Criteria for Survival in Living Donor Liver Transplantation? Sami Akbulut 1 & Cemalettin Koc 1
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose Hepatocellular carcinoma (HCC) is the second leading cause of cancer deaths and the 7th most common cancer. It has two characteristic features: being advanced stage at diagnosis and association with liver cirrhosis. Liver transplantation (LT) offers the only curative option to treat both components of the disease. The Milan criteria have been extensively used for selecting patients with HCC for LT. However, using Milan criteria, we can only transplant 30% of the patients. The aim of the present review is to evaluate the role of LT in HCC beyond the Milan criteria. Methods We evaluated the studies that have introduced extended criteria to select patients with HCC beyond the Milan criteria. We evaluated the outcomes in terms of disease-free survival rates and HCC recurrences. Results There are patients with tumors that are beyond Milan criteria that could benefit from LT. Selection of these patients has paramount importance in the era of living donor liver transplantation. Current expanded criteria depend on either the bulk of the tumor or the additional surrogate markers of tumor biology such as alpha-fetoprotein (AFP) and des-gamma carboxyprothrombin (DCP). Conclusion There is no ideal marker or an extended criterion for selecting patients with HCC beyond the Milan criteria and it needs further research to find an effective biomarker that has prognostic significance to select patients with advanced tumors. Keywords Hepatocellular carcinoma . Milan criteria . Extended criteria . Biomarkers
Abbreviations AFP Alpha-Feto-Protein CRP C-reactive protein CUN Clinica Universitaria de Navarra DCP/PIVKA-Des-carboxyprothrombin/protein induced by II vitamin K absence or antagonist II EpCAM Epithelial Cell Adhesion Molecules DDLT Deceased donor liver transplantation GGT Gamma-Glutamyl Transferase GGT-II GGT Isozyme 2 HCC Hepatocellular carcinoma K19 Keratin 19 LDLT Living donor liver transplantation LRT Locoregional therapy LT Liver transplantation
* Sami Akbulut [email protected] 1
Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, 244280 Malatya, Turkey
MC UNOS NLR MMP2/9
Milan criteria United Organ Sharing Network Neutrophil to lymphocyte ratio Matrix Metalloproteinase 2/9
Introduction Hepatocellular carcinoma (HCC) is the most common primary liver tumor and 2nd most common cause of cancer death [1]. The main features of HCC include advanced stage at diagnosis and association with cirrhosis [2]. Liver transplantation (LT) provides the only means of cure for both the cancer and the cirrhosis [3]. Until 1996, the results of LT for HCC were poor and there were high recurrences [4]. However, Mazzaferro et al. have developed the Milan criteria (MC) which included solitary tumor ≤ 5 cm or ≤ 3 tumor nodules with ≤ 3 cm each
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