UCSF criteria by pre-transplant radiologic study can not assure similar post-transplant results of hepatocellular carcinoma within Milan criteria.

Abstract

The recurrence of hepatocellular carcinoma (HCC) after transplantation is the main limitation of liver transplantation. Therefore, several selection criteria for liver transplantation in HCC patients have been established. The objective of this study was to verify the clinical validity of selection criteria evaluated by pre-transplant radiologic imaging study. Sixty-nine participants were enrolled for this study between September 2005 and May 2007. We analyzed the post-transplant survival and recurrence rate using radiologic selection criteria and other clinical factors. Grouping by pretransplant criteria for liver transplantation, 16 recipients (23.2%) were above Milan criteria and 7 recipients (10.1%) were above UCSF criteria. Nine recipients (13.0%) were grouped as above Milan/below UCSF. The recipients who met Milan showed 85.8% 1-year survival rates, which was comparable to that of non-HCC (91.6%) (p = 0.767). During the post-transplant follow-up period (1-52 months, 14.81 +/- 12.0 months), 16 recurrences (23.2%) were diagnosed. The 1-year recurrence-free survival rate of recipients who met the Milan criteria was 78.6%, and those that did not meet these criteria was 22.7% (p < 0.0001). With regard to UCSF criteria, these percentages were 72.0% and 14.2%, respectively (p < 0.0001). According to a combined grouping, the 1-year recurrence-free survival rate was 25.4% in the above Milan/below UCSF group. There were significant differences among each of the groups (overall p < 0.0001). The application of UCSF criteria that are defined by pre-transplant radiologic findings as patient selection criteria for liver transplantation is limited.