The stratifying value of Hangzhou criteria in liver transplantation for hepatocellular carcinoma

Jun Chen; Xiao Xu; Jian Wu; Qi Ling; Kai Wang; Weilin Wang; Min Zhang; Yan Shen; Lin Zhou; Haiyang Xie; Shusen Zheng

doi:10.1371/journal.pone.0093128

The stratifying value of Hangzhou criteria in liver transplantation for hepatocellular carcinoma

PLoS One. 2014 Mar 27;9(3):e93128. doi: 10.1371/journal.pone.0093128. eCollection 2014.

Authors

Jun Chen¹, Xiao Xu², Jian Wu¹, Qi Ling¹, Kai Wang¹, Weilin Wang¹, Min Zhang¹, Yan Shen¹, Lin Zhou¹, Haiyang Xie¹, Shusen Zheng²

Affiliations

¹ Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China.
² Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang Province, China; Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, Hangzhou, Zhejiang Province, China.

Abstract

Background/aims: The selection criteria for patients with hepatocellular carcinoma (HCC) as candidates for deceased donor liver transplantation (DDLT) are well studied. In this era of limited deceased donor organs, the value of living donor liver transplantation (LDLT) for HCC remains controversial. The aim of the present study was to verify the stratification value of the Hangzhou criteria for LDLT.

Methods: The data of 47 LDLT recipients and 94 matched DDLT recipients at our center were evaluated. Overall survival and tumor-free survival were calculated. Prognostic factors influencing post-liver transplantation (LT) survival were identified. The stratification values of the Hangzhou criteria and Milan criteria were compared.

Results: LDLT recipients spent much less time on the waiting list. The post-LT survival of recipients fulfilling the Milan criteria and recipients fulfilling the Hangzhou criteria were comparable (P>0.05). The overall and tumor-free survival did not differ statistically between the two groups. In both groups, more recipients not meeting the Milan criteria but with a satisfactory outcome were identified by the Hangzhou criteria. Among recipients who did not meet the Hangzhou criteria, tumor-free survival was better for the LDLT recipients than the DDLT recipients (P = 0.024).

Conclusions: The Hangzhou criteria are reliable for stratifying HCC patients in terms of prognosis. HCC patients fulfilling the Hangzhou criteria gain satisfactory survival from LT. Outcomes after LDLT are better than those after DDLT for HCC patients who do not meet the Hangzhou criteria.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Carcinoma, Hepatocellular / diagnosis
Carcinoma, Hepatocellular / mortality
Carcinoma, Hepatocellular / therapy*
Female
Follow-Up Studies
Humans
Liver Cirrhosis / pathology
Liver Neoplasms / diagnosis
Liver Neoplasms / mortality
Liver Neoplasms / therapy*
Liver Transplantation*
Living Donors
Male
Middle Aged
Neoplasm Grading
Neoplasm Metastasis
Neoplasm Recurrence, Local
Neoplasm Staging
Prognosis
Risk Factors
Survival Analysis

Grants and funding

This study is supported by the Foundation for Innovative Research Groups of the National Natural Science Foundation of China (Grant No. 81121002); the National S&T Major Project (No. 2012ZX10002017); the Grant from Zhejiang Provincial Medical Foundation for Young Excellent Scholars (NO. 2008QN012); the National High-tech R&D Program of China (863 Program) (No.2012AA020204); the Medical science and technology plan of Zhejiang province (No.2011ZDA007). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.