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Ichida et al. Hepatoma Res 2020;6:54 Hepatoma Research
DOI: 10.20517/2394-5079.2020.59

Original Article Open Access

Validation of novel Japanese indication criteria and
biomarkers among living donor liver transplantation

recipients with hepatocellular carcinoma - a single
center retrospective study

Akihiko Ichida, Nobuhisa Akamatsu, Kiyoshi Hasegawa
Artificial Organ and Transplantation Surgery Division, Department of Surgery, University of Tokyo, Tokyo 113-8655, Japan.

Correspondence to: Dr. Nobuhisa Akamatsu, Artificial Organ and Transplantation Surgery Division, Department of Surgery,
Graduate school of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
E-mail: nakamats-tky@umin.ac.jp
How to cite this article: Ichida A, Akamatsu N, Hasegawa K. Validation of novel Japanese indication criteria and biomarkers
among living donor liver transplantation recipients with hepatocellular carcinoma - a single center retrospective study. Hepatoma
Res 2020;6:54. http://dx.doi.org/10.20517/2394-5079.2020.59

Received: 18 Jun 2020 First Decision: 28 Jul 2020 Revised: 7 Aug 2020 Accepted: 18 Aug 2020 Published: 21 Aug 2020
Academic Editor: Guang-Wen Cao Copy Editor: Cai-Hong Wang Production Editor: Jing Yu
Received: First Decision: Revised: Accepted: Published:

Science Editor: Copy Editor: Production Editor: Jing Yu
Abstract
Aim: To validate a novel Japanese indication criteria for liver transplantation (LT) for hepatocellular carcinoma
(HCC), i.e., the 5-5-500 criteria (nodule size ≤ 5 cm in diameter, nodule number ≤ 5, and alfa-fetoprotein (AFP)
value ≤ 500 ng/mL) and the Japanese double eligibility criteria (DEC) (patients meeting the Milan or the 5-5-500
criteria) in the University of Tokyo cohort. The usefulness of biomarkers in predicting the recurrence of HCC was
also verified.

Methods: The overall survival and recurrence rates of patients meeting the Milan, 5-5-500, and the Japanese DEC
were compared among 153 patients who underwent living donor LT (LDLT) between 1996 and 2019. A receiver-
operating characteristics curve analysis was conducted to evaluate the usefulness of AFP, lens culinaris agglutinin-
reactive fraction of AFP, des-gamma-carboxy prothrombin, neutrophil-lymphocyte ratio, and the platelet-
lymphocyte ratio to detect recurrence.

Results: The 5-year recurrence rate for all patients, those meeting the Japanese DEC, 5-5-500 criteria, and the
Milan criteria was 10.9%, 9.2%, 7.4%, and 7.6%, respectively. Compared with the conventional Milan criteria, the
5-5-500 criteria and the Japanese DEC could increase the number of eligible LDLT candidates by 6.1% and 11.4%.
Among five biomarkers, the area under the curve value of AFP was the highest (0.852).

© The Author(s) 2020. 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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