Brief Article
Copyright ©2013 Baishideng Publishing Group Co., Limited. All rights reserved.
World J Gastroenterol. Sep 28, 2013; 19(36): 6077-6083
Published online Sep 28, 2013. doi: 10.3748/wjg.v19.i36.6077
Up-to-seven criteria for hepatocellular carcinoma liver transplantation: A single center analysis
Jian-Yong Lei, Wen-Tao Wang, Lu-Nan Yan
Jian-Yong Lei, Wen-Tao Wang, Lu-Nan Yan, Liver Transplantation Center, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Wang WT proposed the study and was the guarantor; Wang WT and Lei JY performed research and wrote the first draft; Lei JY collected and analyzed the data; all authors contributed to the design and interpretation of the study and to further drafts.
Correspondence to: Wen-Tao Wang, MD, PhD, Liver Transplantation Center, West China Hospital of Sichuan University, 29 Wangjiang Road, Chengdu 610041, Sichuan Province, China. ljydoctor@163.com
Telephone: +86-28-85422867 Fax: +86-28-85422867
Received: July 14, 2013
Revised: August 15, 2013
Accepted: August 20, 2013
Published online: September 28, 2013
Processing time: 73 Days and 21.1 Hours
Abstract

AIM: To detect whether the up-to-seven should be used as inclusion criteria for liver transplantation for hepatocellular carcinoma.

METHODS: Between April 2002 and July 2008, 220 hepatocellular carcinoma (HCC) patients who were diagnosed with HCC and underwent liver transplantation (LT) at our liver transplantation center were included. These patients were divided into three groups according to the characteristics of their tumors (tumor diameter, tumor number): the Milan criteria group (Group 1), the in up-to-seven group (Group 2) and the out up-to-seven group (Group 3). Then, we compared long-term survival and tumor recurrence of these three groups.

RESULTS: The baseline characteristics of transplant recipients were comparable among these three groups, except for the type of liver graft (deceased donor liver transplant or live donor liver transplantation). There were also no significant differences in the pre-operative α-fetoprotein level. The 1-, 3-, and 5-year overall survival and tumor-free survival rate for the Milan criteria group were 94.8%, 91.4%, 89.7% and 91.4%, 86.2%, and 86.2% respectively; in the up-to-seven criteria group, these rates were 87.8%, 77.8%, and 76.6% and 85.6%, 75.6%, and 75.6% respectively (P < 0.05). However, the advanced HCC patients’ (in the group out of up-to-seven criteria) overall and tumor-free survival rates were much lower, at 75%, 53.3%, and 50% and 65.8%, 42.5%, and 41.7%, respectively (P < 0.01).

CONCLUSION: Considering that patients in the up-to-seven criteria group exhibited a considerable but lower survival rate compared with the Milan criteria group, the up-to-seven criteria should be used carefully and selectively.

Keywords: Up-to-seven criteria, Liver transplantation, Outcome, Hepatocellular carcinoma, Recurrence

Core tip: The up-to-seven criteria were introduced several years ago, but there is still no consensus about their effectiveness. Two hundred and twenty patients were divided into three groups according to the characteristics of their tumors: the 1-, 3-, and 5-year overall survival and tumor-free survival rate for the Milan criteria group were higher than that in the up-to-seven criteria group. However, the advanced hepatocellular carcinoma patients’ overall and tumor-free survival rates were much lower. So considering that patients in the up-to-seven criteria group exhibited a considerable but lower survival rate compared with the Milan criteria group, the up-to-seven criteria should be used carefully and selectively.