Evaluation of eligibility criteria in living donor liver transplantation for hepatocellular carcinoma by α-SMA-positive cancer-associated fibroblasts

Takamura,Hiroyuki; Nakanuma,Shinichi; Hayashi,Hironori; Tajima,Hidehiro; Kakinoki,Kaheita; Sakai,Seisyo; Makino,Isamu; Nakagawara,Hisatoshi; Miyashita,Tomoharu; Okamoto,Koichi; Nakamura,Keishi; Oyama,Katunobu; Inokuchi,Masashi; Ninomiya,Itasu; Kitagawa,Hirohisa; Fushida,Sachio; Fujimura,Takashi; Ohnishi,Ichiro; Kayahara,Masato; Tani,Takashi; Arai,Kuniaki; Yamashita,Taro; Yamashita,Tatsuya; Kitamura,Hoshiko; Ikeda,Hiroko; Kaneko,Shuichi; Nakanuma,Yasuni; Matsui,Osamu; Ohta,Tetsuo

doi:10.3892/or.2013.2616

Evaluation of eligibility criteria in living donor liver transplantation for hepatocellular carcinoma by α-SMA-positive cancer-associated fibroblasts

Authors:
- Hiroyuki Takamura
- Shinichi Nakanuma
- Hironori Hayashi
- Hidehiro Tajima
- Kaheita Kakinoki
- Seisyo Sakai
- Isamu Makino
- Hisatoshi Nakagawara
- Tomoharu Miyashita
- Koichi Okamoto
- Keishi Nakamura
- Katunobu Oyama
- Masashi Inokuchi
- Itasu Ninomiya
- Hirohisa Kitagawa
- Sachio Fushida
- Takashi Fujimura
- Ichiro Ohnishi
- Masato Kayahara
- Takashi Tani
- Kuniaki Arai
- Taro Yamashita
- Tatsuya Yamashita
- Hoshiko Kitamura
- Hiroko Ikeda
- Shuichi Kaneko
- Yasuni Nakanuma
- Osamu Matsui
- Tetsuo Ohta
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Affiliations: Department of Gastroenterologic Surgery, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan, Department of Gastroenterology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan, Department of Diagnostic Pathology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan, Department of Radiology, Graduate School of Medicine, Kanazawa University, Kanazawa, Ishikawa 920-8641, Japan
Published online on: July 16, 2013 https://doi.org/10.3892/or.2013.2616
Pages: 1561-1574
Copyright: © Takamura et al. This is an open access article distributed under the terms of Creative Commons Attribution License [CC BY_NC 3.0].

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Abstract

The eligibility criteria of liver transplantation (LT) for hepatocellular carcinoma (HCC) must clearly confirm the prognosis not only from pathological diagnosis but also from pre-operative imaging diagnosis. In the present study, we evaluated published eligibility criteria for LT based on both pre-operative imaging diagnosis and pathological diagnosis using living donor liver transplantation (LDLT) recipients at our hospital by α-smooth muscle actin (SMA)-positive cancer‑associated fibroblasts (CAFs) in HCC. The Up-to-seven (Up‑to‑7), Asan and Tokyo criteria were evaluated, in both overall survival and HCC disease‑free survival, to be statistically significantly beneficial criteria to define post-LDLT prognosis. Recipients only within Up‑to‑7 criteria based on both pre-operative imaging diagnosis and pathological diagnosis survived without HCC recurrence. Recipients with proliferation of α-SMA‑positive CAFs in HCC had significantly poorer prognosis. All survival recipients without HCC recurrence, who were above the Up‑to‑7 criteria in pathological diagnosis, had no proliferation of α-SMA-positive CAFs. As a result of multivariate analysis, the significant independent factors defining prognosis of recipients after LDLT for HCC were Up‑to‑7 criteria and proliferation of α-SMA-positive CAFs. The ideal eligibility criteria for LDLT with HCC is Up‑to‑7 criteria and α-SMA-positive CAFs was considered to be an important factor in HCC recurrence. LDLT should be limited to recipients within Up‑to‑7 criteria or without proliferation of α-SMA-positive CAFs.

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