Impact of pretreatments on outcomes after living donor liver transplantation for hepatocellular carcinoma

Background The purpose of this study was to examine the impact of pretreatments on outcomes after living donor liver transplantation (LDLT) for hepatocellular carcinoma (HCC). Methods From February 1999 to March 2015, 223 patients underwent LDLT for HCC. Until December 2006, there was no restriction in patient selection criteria regarding the number and size of tumors, following which we implemented the Kyoto criteria (tumor number <= 10, maximal diameter <= 5 cm, and des-gamma-carboxy prothrombin <= 400 mAU/ml) since January 2007. Results Of 223 patients, 156 had a history of pretreatments. Among 101 patients meeting the Milan criteria at the initial diagnosis, 38 progressed to beyond the criteria at liver transplantation (LT). Twenty-two out of 38 met the Kyoto criteria, and their survival and recurrence rates were significantly better than those of patients exceeding the Kyoto criteria (P = 0.004 and 0.035, respectively). Regarding the number of pretreatments (0 vs. 1-4 vs. >= 5), recurrence rate was significantly higher in the >= 5 pretreatments group than the 0 group. However, for patients meeting the Kyoto criteria, there were no significant differences in recurrence rates between these three groups. Conclusion Better outcomes will be achieved by performing LT for HCCs meeting the Kyoto criteria even after repeated pretreatments.