• Yücel Yankol, Gültekin Hoş, Turan Kanmaz, Nesimi Mecit, Yılmaz Çakaloğlu, Münci Kalayoğlu, and Koray Sadık Acarlı.
• Division of Transplantation, Department of Surgery, School of Medicine and Public Health, University of Wisconsin, Madison, WI, United States, Organ Transplant Center, Memorial Şişli Hospital, İstanbul, Turkey.
• Turk J Med Sci. 2021 Oct 21; 51 (5): 238323952383-2395.

Background/AimWith the increased experience in living donor liver transplantation (LDLT), it has been adopted for the treatment of hepatocellular carcinoma (HCC), with emerging discussions of criteria beyond tumor size and number. In contrast to deceased donor liver transplantation (DDLT), recipient selection for LDLT is not limited by organ allocation systems. We discuss herein the assessment, criteria, and experience with liver transplantation (LT) in HCC cases at a high-volume LDLT center.Material And MethodsBetween August 2006 and December 2017, 191 adult LT HCC recipients with at least one-year follow-up were retrospectively analyzed.ResultsIn 191 patients, one-, three- and five-year survival rates were 87.2%, 81.6%, and 76.2%, respectively, including early postoperative mortality. In 174 patients with long-term follow-up, one-, three- and five-year disease-free survival rates were 91.6%, 87.7%, and 84.4%, respectively. When multivariate analysis was utilized, tumor differentiation was the only factor which statistically affected survival (p = 0.025).ConclusionLDLT allows us to push the limits forward and the question “Are the criteria always right?” is always on the table. We can conclude that, with the advantage of LDLT, every HCC patient deserves a case-by-case basis discussion for LT under scientific literature support. In borderline cases, tumor biopsy might help determine the decision for LT.This work is licensed under a Creative Commons Attribution 4.0 International License.

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