Comparison of hepatitis B prophylactic outcomes in living donor liver transplantation recipients who meet the Milan or UCSF criteria

BackgroundThe tumor burden before liver transplantation indicates that hepatitis B virus (HBV) may hide in the extrahepatic and micrometastatic sites which serve as a source of HBV replication. Currently, many liver transplant centers, especially in Western countries, use the Milan or UCSF criteria to select patients with hepatocellular carcinoma for liver transplantation. This study was undertaken to compare the HBV prophylactic outcomes in two groups of living donor liver transplantation (LDLT) recipients. Patients in group A met the Milan criteria and those in group B exceeded the Milan criteria but were within the UCSF criteria.MethodsA database of adult-to-adult right-lobe LDLT performed at our institution for HBV-related hepatocellular carcinoma within the Milan or UCSF criteria between June 2002 and May 2012 was used to compare the HBV prophylactic outcomes between patients within the Milan criteria (group A, 41 patients) and those exceeding the Milan criteria but within the UCSF criteria (group B, 19 patients).ResultsThe 1-, 3-, and 5-year survival rates were similar between groups A and B (87.8%, 85.1% and 74.0% vs 73.3%, 61.1% and 61.1%, respectively, P=0.067). HBV recurred in 1 patient in 3.1 months after LDLT in group A and in 2 patients in group B (1 in 11.9 months and 1 in 24.1 months after LDLT). The 1-, 3-, and 5-year HBV recurrence rates were 2.6%, 2.6% and 2.6% in group A, and 7.3%, 17.9% and 17.9% in group B, respectively (P=0.118).ConclusionLDLT recipients who exceed the Milan criteria but remain within the UCSF criteria may have post-transplant HBV prophylactic outcomes similar to those who meet the Milan criteria.