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Liberal selection criteria for liver transplantation for hepatocellular carcinoma
British Journal of Surgery, 06/25/09

Muscari F et al. - In a study to compare the safety and feasibility of new, more liberal, selection criteria—no more than 5 tumours, with the largest tumour no greater than 5 cm (5/5 criteria)—with classical criteria, it appears that use of the more liberal 5/5 criteria for selecting pts for liver transplantation results in similar disease-free and overall survival rates to classical criteria.

Methods

Data from operations performed in 1990-2005 were extracted from preoperative radiological findings and postoperative specimen analyses, and 4 groups were constructed: Paul Brousse, Milan, University of California, San Francisco (UCSF), and 5/5 criteria.
A fifth group comprised pts whose tumour load exceeded the 5/5 criteria.
Survival and recurrence rates were compared.

Results

For the 110 pts in the study, survival rates (overall and disease-free) were 72.8 and 66.8% at 5 and 10 yrs respectively, with a 5.5% recurrence rate.
5-yr survival rate was 65, 77, 68 and 77% for Paul Brousse, Milan, UCSF, and 5/5 preoperative radiological criteria, with recurrence rates of 4, 4, 3 and 3%, respectively.
On multivariable analysis, the only factor that influenced survival was tumour load in excess of the 5/5 criteria.

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