Hepatocellular carcinoma (HCC) with distant metastasis is an absolute contraindication for liver transplantation (LT). However, it is still unclear whether LT is feasible or acceptable in such patients, albeit after being treated with a multidisciplinary approach and after any metastatic lesion is ruled out. We report one such successful treatment with living donor LT (LDLT) after completely controlling far-advanced HCC with inferior vena cava tumor thrombosis and multiple lung metastases. The patient has been doing well without HCC recurrence for eight years since LDLT. The current patient could be an anecdotal case, but provides a case for expanding LDLT indications in the context of advanced HCC and suchlike.
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Small graft size and hepatocellular carcinoma outcomes in living donor liver transplantation: a retrospective multicentric cohort study Deok-Gie Kim, Shin Hwang, Kwang-Woong Lee, Jong Man Kim, Young Kyoung You, Donglak Choi, Je Ho Ryu, Bong-Wan Kim, Dong-Sik Kim, Jai Young Cho, Yang Won Nah, Man ki Ju, Tae-Seok Kim, Jae Geun Lee, Myoung Soo Kim, Alessandro Parente, Ki-Hun Kim, Andrea Schl International Journal of Surgery.2024;[Epub] CrossRef
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Inferior Vena Cava Thrombectomy and Stenting as Bridge to Liver Transplantation After Radiotherapy-Induced Thrombosis Raphael PH Meier, Shani Kamberi, Josue Alvarez-Casas, Barton F. Lane, Chandra S. Bhati, Saad Malik, William Twaddell, Kirti Shetty, Adam Fang, Hyun S. Kim, Daniel G. Maluf Progress in Transplantation.2023; 33(4): 356. CrossRef
Liver transplantation is the prime management for early hepatocellular carcinoma with liver cirrhosis that is not
candidate for surgical resection. Milan criteria, single tumor less than 5 cm or less than three tumors with less
than 3 cm, is accepted as an indication for liver transplantation. The extended criteria do not show reliable result
in long-term recurrent-free survival rate. Shortage of donor and following high drop-out rate during waiting time
are main obstacle to liver transplantation, which can be alleviated by the living donor liver transplantation and
priority policies in deceased donor liver allocation. The pre-operative loco-regional therapy, such as transarterial
chemoembolization (TACE), radiofrequency ablation (RFA) and regional surgical resection, decreases the drop-out
rate for waiting time and supplies time for preparing the liver transplantation. Generally acceptable recurrence rate
after liver transplantation is less than 15%. The size of mass, vascular or lymphatic-invasion, low grade tumor
and high pre-operative level of alpha-Fetoprotein (AFP) are risk factors for recurrence. The prognosis of recurred
hepatocellular carcinoma is fatal. Neoadjuvant chemotherapy after liver transplantation cannot prolong the patient
survival rate and decrease the recurrence rate. Above 50% of recurrence-free patient survival rate at
post-transplant 5 years is reliable result after liver transplantation in hepatocellular carcinoma. The survival rate
is improved after mid-1990, and is reported as 60-70% at post-transplant 5 years. The living donor liver
transplantation shows more superior survival rate than deceased donor liver transplantation.