Preprint Article Version 1 Preserved in Portico This version is not peer-reviewed

Liver Transplantation for Hepatocellular Carcinoma beyond Milan Criteria

Oliver Rohland
* ORCID logo ,
Lea Freye
,
Laura Schwenk
,
Aladdin Ali-Deeb
ORCID logo ,
Michael Ardelt
,
Astrid Bauschke
,
Utz Settmacher
,
Falk Rauchfuß
,
Felix Dondorf
*
Version 1 : Received: 19 January 2024 / Approved: 22 January 2024 / Online: 22 January 2024 (10:08:45 CET)

A peer-reviewed article of this Preprint also exists.

Rohland, O.; Freye, L.; Schwenk, L.; Ali-Deeb, A.; Ardelt, M.; Bauschke, A.; Settmacher, U.; Rauchfuß, F.; Dondorf, F. Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy. Cancers 2024, 16, 920. Rohland, O.; Freye, L.; Schwenk, L.; Ali-Deeb, A.; Ardelt, M.; Bauschke, A.; Settmacher, U.; Rauchfuß, F.; Dondorf, F. Liver Transplantation for Hepatocellular Carcinoma beyond the Milan Criteria: A Specific Role for Living Donor Liver Transplantation after Neoadjuvant Therapy. Cancers 2024, 16, 920.

Abstract

Purpose: This study aimed to elucidate the various new classifications and the use of LDLT in this context for HCC beyond milan criteria. Methods: The clinical data of patients with HCC outside milan criteria who underwent LT at Jena University between Januar 2007 and August 2023 were retrospectively analyzed. Eligible patients were classified according to various classification systems. Clinicopathological features, overall- and disease-free survival rates were compared between the two groups (LT vs. LDLT) and in context for bridging therapy. Results: Among the 245 patients analyzed, 120 patients were outside milan criteria and 125 patients were inside milan. There was no significant difference for patients outside milan in overall survival for LT versus LDLT (OS 44,3 months vs. 28,3 months; 5y survival, 56,4% vs. 40%; p = 0.84). G3 tumor differentiation, presence of angioinvasion and lack of bridging were statistically significant risk factors predicting tumor recurrence in univariate and multivariate analysis (HR 6.34; p = 0.0002; HR 8.21; p < 0.0001; HR 7.50; p = 0.0001). Bridging therapy before transplantation provides a significant survival advantage regardless of the transplant procedure (OS: p = 0.008 ; DFS: p < 0.001). Conclusions: Patients with HCC outside milan criteria who underwent LT or LDLT had comparable outcome to patients inside milan criteria. Nevertheless, these patients remain disadvantaged on the waiting list, which is why LDLT represents a safe alternative to LT and should be considered in bridged HCC patients depending on tumor differentiation, size and tumor marker dynamics.

Keywords

hepatocellular carcinoma; Milan criteria; living-donor liver transplantation; transplant outcome

Subject

Medicine and Pharmacology, Transplantation

Copyright: This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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