Hepatocellular carcinoma: a prime indication for living donor liver transplantation.

GONDOLESI G; MUÑOZ L; MATSUMOTO C; FISHBEIN T; SHEINER PA; EMRE SH; MILLER C; SCHWARTZ ME.

JOURNAL OF GASTROINTESTINAL SURGERY : OFFICIAL JOURNAL OF THE SOCIETY FOR SURGERY OF THE ALIMENTARY TRACT.

SPRINGER

Lugar: Berlin; Año: 2002 vol. 6 p. 102 - 107

1091-255X

Cadaveric liver transplantation for hepatocellular carcinoma (HCC) is limited by donor organ availability.This report reviews our initial experience with living donor liver transplantation (LDLT) for HCC. SinceAugust 1998, a total of 71 adults have undergone LDLT; 27 (38%) for HCC. Underlying diagnoses includedhepatitis C in 17, hepatitis B in eight, cryptogenic cirrhosis in one, and primary biliary cirrhosis inone. Four patients had recurrent HCC after resection. Patients with tumors measuring 5 cm or larger receiveda single dose of intravenous doxorubicin intraoperatively and six cycles of doxorubicin at 3-week intervalsbeginning 6 weeks postoperatively. All HCC patients are followed with CT scans and alpha-fetoproteinmeasurements every 3 months during the first 2 years after transplant. Mean waiting time to transplantfor patients with HCC was 83 days, compared to 414 (P 0.001) days for 50 patients with HCC who weretransplanted with cadaveric organs during this period. At median follow-up of 236 days, there have beenfour deaths due to non?tumor-related causes and one death from recurrence; recurrence has been observedin one other patient. LDLT permits expeditious transplantation in patients with early HCC, and providesaccess to transplantation for patients with HCC exceeding the United Network of Organ Sharing criteriafor prioritization who are, in effect, barred from receiving cadaveric organs. ( J GASTROINTEST SURG2002;6:102?107.) © 2002 The Society for Surgery of the Alimentary Tract, Inc.