The Possibility of Radiotherapy for Downstaging before Living Donor Liver Transplantation for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis = The Possibility of Radiotherapy for Downstaging before Living Donor Liver Transplantation for Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis

다국어 초록 (Multilingual Abstract)

Aims: Advanced HCC with portal vein tumor thrombus (PVTT) patients are excluded for liver transplantation (LT), according to the Milan criteria. But after the development of conformal RT, there have been several trials on RT as a bridge or downstaging management approach to LT. The purpose of our study is to evaluate the value of living donor liver transplantation (LDLT) following RT in PVTT patients. Methods: This study took place between May 1996 and March 2013; a, total of 1360 patients were treated by LT in our institution, and 5 of those recipients had RT due to PVTT. To confirm the value of LDLT following RT in PVTT, we did a propensity-matched study retrospectively. Results: There were no statistically significant differences in the clinical characteristics of the two groups. All LT was done by LDLT with duct to duct anastomosis and the mean operation time was 588 minutes. During the follow-up periods, in the LDLT following RT group, two recipients exhibited disease progression, but in the RT alone group, all patients had tumor ingrowths or either intra- or extra- hepatic metastasis. The OS for the LDLT following RT group was 1055 days and that of the RT alone group was 367 days, and there was a statistically significant difference. Conclusions: LDLT following RT can be the treatment of choice for PVTT in select patients and when bile duct anastomosis was performed in RT recipients, a hepaticojejunostomy was recommended to prevent biliary complications.