Retrospective Study
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Jan 27, 2020; 12(1): 17-27
Published online Jan 27, 2020. doi: 10.4240/wjgs.v12.i1.17
Outcomes associated with the intention of loco-regional therapy prior to living donor liver transplantation for hepatocellular carcinoma
Tsung-Han Wu, Yu-Chao Wang, Chih-Hsien Cheng, Chen-Fang Lee, Ting-Jung Wu, Hong-Shiue Chou, Kun-Ming Chan, Wei-Chen Lee
Tsung-Han Wu, Yu-Chao Wang, Chih-Hsien Cheng, Chen-Fang Lee, Ting-Jung Wu, Hong-Shiue Chou, Kun-Ming Chan, Wei-Chen Lee, Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, Taoyuan 33305, Taiwan
Kun-Ming Chan, Department of Organs Transplantation Institute, Chang Gung University College of Medicine, Taoyun 33305, Taiwan
Author contributions: Wu TH drafted the manuscript; Chan KM, Wu TH, Cheng CH, Wu TJ, Chou HS, and Lee WC contributed to the acquisition of data; Chan KM and Lee WC contributed to the critical revision of the manuscript for important intellectual content; all authors contributed to the work.
Institutional review board statement: This study was fully approved by the internal review board of Chang Gung Memorial Hospital at Linkou (Approval No.: 99-3089B), and informed consent from patient was waived due to its retrospective nature.
Informed consent statement: Patients were not required to give informed consent to the study because the analysis used anonymous clinical data that were obtained after each patient agreed to treatment by written consent.
Conflict-of-interest statement: The authors have no conflicts of interest.
Data sharing statement: No additional data are available. All data generated or analyzed during this study are included in this published article.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Kun-Ming Chan, MD, Associate Professor, Chief Doctor, Surgeon, Department of General Surgery and Chang Gung Transplantation Institute, Chang Gung Memorial Hospital at Linkou, Chang Gung University College of Medicine, 5 Fu-Hsing Street, Gui-Shan District, Taoyuan 33305, Taiwan. chankunming@cgmh.org.tw
Received: October 3, 2019
Peer-review started: October 3, 2019
First decision: October 24, 2019
Revised: November 6, 2019
Accepted: November 28, 2019
Article in press: November 28, 2019
Published online: January 27, 2020
Abstract
BACKGROUND

Loco-regional therapy for hepatocellular carcinoma (HCC) during the period awaiting liver transplantation (LT) appears to be a logical approach to reduce the risk of tumor progression and dropout in the waitlist. Living donor LT (LDLT) offers a flexible timing for transplantation providing timeframe for well preparation of transplantation.

AIM

To investigate outcomes in relation to the intention of pre-transplantation loco-regional therapy in LDLT for HCC patients.

METHODS

A total of 308 consecutive patients undergoing LDLTs for HCC between August 2004 and December 2018 were retrospectively analyzed. Patients were grouped according to the intention of loco-regional therapy prior to LT, and outcomes of patients were analyzed and compared between groups.

RESULTS

Overall, 38 patients (12.3%) were detected with HCC recurrence during the follow-up period after LDLT. Patients who were radiologically beyond the University of California at San Francisco criteria and received loco-regional therapy as down-staging therapy had significant inferior outcomes to other groups for both recurrence-free survival (RFS, P < 0.0005) and overall survival (P = 0.046). Moreover, patients with defined profound tumor necrosis (TN) by loco-regional therapy had a superior RFS (5-year of 93.8%) as compared with others (P = 0.010).

CONCLUSION

LDLT features a flexible timely transplantation for patient with HCC. However, the loco-regional therapy prior to LDLT does not seem to provide benefit unless a certain effect in terms of profound TN is noted.

Keywords: Hepatocellular carcinoma, Loco-regional therapy, Living donor liver transplantation, Outcomes, Tumor necrosis, Liver transplantation

Core tip: Liver transplantation (LT) has become an ideal treatment for liver cirrhosis associated with hepatocellular carcinoma (HCC) as it simultaneously removes the tumors and cures the underlying liver cirrhosis. Living donor LT (LDLT) offers a flexible timing for transplantation providing timeframe for well preparation of transplantation. The study investigates the outcome in relation to the intention of pre-transplantation loco-regional therapy in LDLT for HCC. Although the study is still unable to establish a definitive therapeutic protocol to achieve a beneficial outcome of HCC after LDLT, achieving profound tumor necrosis by loco-regional therapy could also offer better outcomes for patients undergoing LDLT for HCC.