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Sugawara et al. Hepatoma Res 2018;4:33 Hepatoma Research
DOI: 10.20517/2394-5079.2018.69

Review Open Access

Living donor liver transplantation for patients with
hepatocellular carcinoma in Japan

Yasuhiko Sugawara, Hidekazu Yamamoto, Taizo Hibi

Department of Transplantation/Pediatric Surgery, Postgraduate School of Life Science, Kumamoto University, Kumamoto
8603-8556, Japan.
Correspondence to: Dr. Yasuhiko Sugawara, Department of Transplantation/Pediatric Surgery, Postgraduate School of Life
Science, Kumamoto University, 1-1-1 Honjo, Chuo-ku, Kumamoto 8603-8556, Japan. E-mail: yasusuga-tky@umin.ac.jp

How to cite this article: Sugawara Y, Yamamoto H, Hibi T. Living donor liver transplantation for patients with hepatocellular
carcinoma in Japan. Hepatoma Res 2018;4:33. http://dx.doi.org/10.20517/2394-5079.2018.69

Received: 25 May 2018 First Decision: 12 Jun 2018 Revised: 29 Jun 2018 Accepted: 3 Jul 2018 Published: 10 Jul 2018

Science Editor: Guang-Wen Cao Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

Abstract
Liver transplantation has now been an established treatment for hepatocellular carcinoma and cirrhosis. The Milan
criteria have been accepted and applied widely in the world as an indication for deceased donor liver transplant.
Due to the severe organ shortage, however, living donor liver transplant (LDLT) has accounted for the majority of
transplantations in Japan and the other Asian countries/regions. LDLT cannot be limited by the restrictions imposed by
the allocation system but depends on institutional criterion or case-by-case considerations. Accumulating data from a
nationwide survey and each center experience have indicated that extending the Milan criteria is warranted.

Keywords: Liver transplantation, living donor, hepatocellular carcinoma

INTRODUCTION
Liver transplantation has now become a standard therapy for patients with hepatocellular carcinoma
(HCC) in the early-stage . Liver transplantation can treat both the tumors and the underlying liver disease.
[1]
Therefore patients who receive transplants theoretically have higher chance of cure than the other treatments
for HCC .
[2]

Early outcome following liver transplantation was poor, associated with high incidence of HCC recurrence
[3]
after transplantation. However, Mazzaferro et al. proposed the criteria to restrict liver transplantation to
[4]
only those patients with HCC of a single tumor ≤ 5 cm or two or three tumors ≤ 3 cm without major vessel
invasion or extrahepatic tumor spread based on the imagings. They showed a 4-year patient survival of 75%

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use,
sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long
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