Liver Transplantation for Hepatocellular Carcinoma: Validation of the UCSF‐Expanded Criteria Based on Preoperative Imaging

• Published in: American journal of transplantation Vol. 7; no. 11; pp. 2587 - 2596
• Main Authors: Yao, F. Y., Xiao, L., Bass, N. M., Kerlan, R., Ascher, N. L., Roberts, J. P.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.11.2007; Blackwell
• Subjects: Biological and medical sciences; Carcinoma, Hepatocellular - mortality; Carcinoma, Hepatocellular - pathology; Carcinoma, Hepatocellular - surgery; Cohort Studies; Disease-Free Survival; Gastroenterology. Liver. Pancreas. Abdomen; Hepatocellular carcinoma; Humans; Liver Neoplasms - mortality; Liver Neoplasms - pathology; Liver Neoplasms - surgery; liver transplantation; Liver Transplantation - mortality; Liver Transplantation - physiology; Liver, biliary tract, pancreas, portal circulation, spleen; Liver. Biliary tract. Portal circulation. Exocrine pancreas; Medical sciences; Neoplasm Staging; Patient Selection; Probability; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Survival Analysis; Time Factors; Tumors; UCSF criteria; Validation; Digestive system; Hepatic disease; Hepatocellular carcinoma; Malignant tumor; Homotransplantation; Liver cancer; Treatment; Criterion; Surgery; Digestive diseases; Graft; Medical imagery; Preoperative; UCSF criteria; Expansion; Liver transplantation
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/j.1600-6143.2007.01965.x

We previously suggested that in patients with heptocellular carcinoma (HCC), the conventional Milan criteria (T1/T2) for orthotopic liver transplantation (OLT) could be modestly expanded based on pathology (UCSF criteria). The present study was undertaken to prospectively validate the UCSF criteria based on pretransplant imaging. Over a 5‐year period, the UCSF criteria were used as selection guidelines for OLT in 168 patients, including 38 patients exceeding Milan but meeting UCSF criteria (T3A). The 1‐ and 5‐year recurrence‐free probabilities were 95.9% and 90.9%, and the respective survivals without recurrence were 92.1% and 80.7%. Patients with preoperative T1/T2 HCC had 1‐ and 5‐year recurrence‐free probabilities of 95.7% and 90.1%, respectively, versus 96.9% and 93.6%, respectively, for preoperative T3A stage (p = 0.58). Under‐staging was observed in 20% of T2 and 29% of T3A HCC (p = 0.26). When explant tumor exceeded UCSF criteria (15%), the 1‐ and 5‐year recurrence‐free probabilities were 80.4% and 59.5%, versus 98.6% and 96.7%, respectively, for those within UCSF criteria (p < 0.0001). In conclusion, our results validated the ability of the UCSF criteria to discriminate prognosis after OLT and to serve as selection criteria for OLT, with a similar risk of tumor recurrence and under‐staging when compared to the Milan criteria. The UCSF criteria for hepatocellular carcinoma applied as selection criteria for liver transplantation based on pre‐operative imaging are associated with excellent post‐transplant survival, without a higher risk of tumor recurrence or under‐staging than the Milan criteria.