Liver Transplantation for Hepatocellular Carcinoma with Expanded Criteria: Malatya Experience

Objectives: The aim of this study is to present updated data on liver transplantation (LT) for hepatocellular carcinoma (HCC) of Inonu University, Liver Transplantation Institute, one of the largest volume liver transplant centers in the world.
Methods: The data of 492 LT patients with HCC were analyzed retrospectively from the databank which is recorded prospectively and sequentially. Post-transplant recurrence rates and patient survival according to Milan, Malatya and Expanded Malatya criteria were calculated. Milan Expansion rate of the Malatya and Expanded Malatya criteria were also calculated.
Results: Median follow-up period of the total cohort was 11.1±1.6 years (8.0–14.2, 95% CI) and the recurrence rate was 18.5 % (91/492). 5-year OS according to Milan, Malatya and Expanded Malatya criteria in our cohort were 80%, 79.3% and 78.4%, respectively. Post-transplant recurrence rates within these criteria were 3.2%, 3.8%, and 4.7%, respectively. Milan expansion rates were 25.2% for Malatya criteria and 35.2% for Expanded Malatya criteria.
Conclusion: Milan criteria can be expanded reasonably by Expanded Malatya criteria. Low GGT and low AFP are good prognostic biomarkers that predict survival following LT in patients with HCC. Patients within Expanded Malatya Criteria had 78.4% 5-year OS, 4.7% post-transplant recurrence rate and Expanded Malatya criteria expanded the Milan criteria by 35.2%. Thus, 88 patients were beyond Milan criteria and were within Expanded Malatya criteria and so had an opportunity for LT.