The Influence of Milan Criteria on the Results of Liver Transplantation for HCC: 1667

Introduction and aim: Milan criteria are generally accepted in lot of transplant centers as a basis for selecting patients with cirrhosis and hepatocellular carcinoma (HCC) for liver transplantation (oltx). The aim is the analysis of the survival of the adult cadaveric liver transplant recipients transplanted for HCC and HCC recurrence dependently on Milan criteria and additional treatment before oltx. Material: In the period 1989 - December 2011, 1030 orthotopic liver transplantations (oltx) were performed, including 53 retransplantations. HCC (as a primary indication for oltx and accidentally findings as well) was identified in 107 patients. Patients' age: 20-68 years (avg=53.7, sd=9.5), gender F/M: 35/72 54 patients had HCV related cirrhosis, 24 - HBV related cirrhosis, 12 - HBV and HCV related cirrhosis, 7 - alcoholic cirrhosis and 6 - cryptogenic cirrhosis, 4 patients - without cirrhosis. 42 patients had additional treatment prior to oltx (39%) including: liver resection, cryoablation, radiofrequency ablation (RFA), trans-arterial chemoembolization (TACE) Results: Milan criteria were met in 40 patients (37%). HCC recurrence was observed in 14 patients (13%): in Milan group - 4 patients (10%), in non-Milan group - 10 patients (14.9%). HCC recurrence in group additionally treated before oltx= 4 patients (28.6%), in non-treated group =10 (71.4%) respectively. Mortality: 17 patients (15.89%): 8 patients in Milan group (20%), 9 patients in non-Milan group (13.4%) respectively. 9 patients died in HCC recurrence group (64.3%) and 8 patients in nonrecurrence group (8.6%). 6-years survival in the non-HCC group = 80%, in the HCC group =75%, p=0.94 (Log-Rank Test) 1-year survival in Milan group = 95%, in non-Milan group = 90% and 6-years survival 75% and 81% respectively, p=0.61 (Log-Rank Test). 1-year survival in HCC non-recurrence group = 92%, in HCC recurrence group = 92% and 6-years survival 90% and 20% respectively, p< 0.05 (Log-Rank Test). 1-year survival in additionally treated before oltx group = 91%, in nontreated group =94% and 6-years survival 70% and 81% respectively, p=0.32 (Log-Rank Test). Conclusions: Strict Milan criteria (including vascular invasion histologically confirmed) met only 37% patients with HCC. HCC recurrence was more frequent in non-Milan group and in group non-treated additionally before oltx. Survival in Milan and non-Milan group was similar without statistical significance (p=0.61). Patients' survival was affected in particular by HCC recurrence after oltx (p< 0.05) which was strictly related to Milan criteria fulfilled and additional treatment before oltx.