Living donor liver transplantation for the patient with hepatocellular carcinoma

Since 1989, over 3,000 living donor liver transplantation (LDLTx) were performed in Japan. Among them, LDLTx for advanced hepatocellular carcinoma (HCC) with severe liver cirrhosis have recently increased. LDLTx for HCC has been offered only when liver function was severely impaired, or HCC became uncontrollable by other modalities such as hepatic resection or ablation therapies, which often exceeded the Milan criteria. One-and 3-year survivals were 84.6% and 73.3%, respectively. When exceeding the Milan criteria, tumor size over 5 cm, vascular invasion, grade of histologic differentiation of HCC, and high PIVKA-II over 300 mAU/ml were independent risk factors for HCC recurrence. Prevention of HCC or hepatitis C recurrence after transplantation should be resolved to improve graft and patient survival.