ONGA-NAKAMA Medical Association Onga Hospital, Japan
Title: Liver transplantation for hepatocellular carcinoma
Taketoshi Suehiro has completed his MD (1989) and PhD (2000) from Kyushu University. He did the clinical training and research of the liver transplantation in Mount Sinai Hospital, New York from 1993 to 1996. He is Assistant Director of Onga-Nakama Medical Association Onga Hospital. His specialty is wide with digestive organ surgery, endoscope, infectious disease, nutrition and so on. He has published more than 70 papers in surgical journals and has been serving as an Editorial Board Member of Hepato-Gastroenterology Journal.
Hepatocellular carcinoma (HCC) oft en occurs in the chronic liver disease and cirrhosis and the resectability of a tumor is limited by the diminished functional reserve of the cirrhotic liver. For these cirrhotic patients, liver transplantation (LTx) is the only potentially curative treatment options for HCC. Milan criteria is a gold selection criteria for HCC patients in LTx. However, a major question is whether tumor size and number are only determinants for recurrence or not. I am going to show not only tumor factors expressing malignant potentials but also host factors such as immune suppression closely related to recurrence. In the recent reports, explant pathology clearly showed signifi cant rates of under- and over-estimated cases before LTx. In addition, signifi cant number of patients, who did not meet the Milan criteria, were reported to survive. Up to now, tumor size, vascular invasion and poorly diff erentiated histology are well-known risk factors for recurrence. Exclusion of poorly diff erentiated HCC by preoperative tumor biopsy was reported to bring a better survival. Several tumor biological indicators such as microsatellite markers were reported as predictive indicators of recurrence. Detection of micrometastasis in bone marrow or circulating tumor cells using such as AFP and telomerase mRNA suggested the possibility to predict recurrence. In my series of living donor LTx, a multivariate analysis revealed des-gamma-prothrombin (DCP) of over 300 mAU/ml and tumor size of over 5cm were independent prognostic factors. HCC recurrence aft er LTx is not determined by only tumor size or number. An order-made criterion should be urgently established using updating molecular biological methods.