Efficacy Of Locoregional Treatment For Hepatocellular Carcinoma Prior To Living Donor Liver Transplantation

e15131 Background: It has been reported that pre-operative treatment before liver transplantation (LT) for hepatocellular carcinoma (HCC) improves the long-term outcome. The aim of this study was to review our experience in single institution for multidisciplinary pre-transplant treatment of HCC and the impact of its efficacy on downstaging within Milan criteria (MC) prior to LT. Methods: From April 2000 to December 2013, we performed living donor LT for 34 patients who were pathologically diagnosed as HCC, including four patients who were detected HCC incidentally by post-operative pathological evaluation. We retrospectively evaluated the clinicopathological features of HCC and the long-term outcome after LT. Results: The over-all survival of patients with HCC, which was determined pre-operatively as beyond MC, was significantly lower than that with HCC within MC. Interestingly, there is no significant difference in overall survival between patients within and MC by pathological evaluation. Over-all survival of the patients who were downstaged pre-operatively within MC by locoregional treatment was improved. More interestingly, if the Patients were successfully downstaged within MC by pre-operative loco-regional treatment, survival rate was statistically similar to that of the patients who were within MC pre-operatively and got no locoregional treatment prior to LT. The predictive factors associated with over-all survival rate were pre-transplant diagnosis being beyond MC and vascular invasion. Conclusions: Pre-transplant clinical diagnosis based on MC is still valuable for exclusive criteria of the candidate for LT to achieve long-term survival. In this context, locoregional treatment prior to LT was significantly effective for downstage therapy.