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Feier. Hepatoma Res 2020;6:75 Hepatoma Research
DOI: 10.20517/2394-5079.2020.68

Perspective Open Access

Should selection criteria for HCC be the same (or
different) between LDLT and DDLT?

Flavia Feier 1,2

1 Liver Transplantation Department, Hospital de Clinicas de Porto Alegre, Porto Alegre 90035-903, Brazil.
2 Pediatric Liver Transplantation Department, Irmandade Santa Casa de Porto Alegre, Porto Alegre 90020-090, Brazil.
Correspondence to: Dr. Flavia Feier, Liver Transplantation Department, Hospital de Clinicas de Porto Alegre, Rua Ramiro Barcelos
2350, Porto Alegre 90035-903, Brazil. E-mail: flavia.feier@gmail.com
How to cite this article: Feier, F. Should selection criteria for HCC be the same (or different) between LDLT and DDLT? Hepatoma
Res 2020;6:75. http://dx.doi.org/10.20517/2394-5079.2020.68
Received: 19 Jul 2020 First Decision: 8 Sep 2020 Revised: 9 Sep 2020 Accepted: 14 Sep 2020 Published: 6 Nov 2020

Academic Editor: Nobuhisa Akamatsu Copy Editor: Cai-Hong Wang Production Editor: Jing Yu

Abstract
Since the Milan Criteria (MC) were adopted in many countries as the allocation policy criteria for patients with
Received: First Decision: Revised: Accepted: Published:
hepatocellular carcinoma to be transplanted, many groups started to expand it to provide a chance for patients
Science Editor: Copy Editor: Production Editor: Jing Yu with tumors outside the MC who could achieve similar survival rates. With the scarcity of deceased donors,
Asian countries improved the results with living donor liver transplantation, allowing patients outside MC to be
transplanted with a living donor. Newer prognostic models and a more profound understanding of tumor behavior
are targeting better patient selection. Currently, patients are unevenly selected for liver transplantation and mostly
separated into those fulfilling the MC and transplanted with a deceased donor and those with expanded criteria
and transplanted with a living donor. In this paper, insight is brought into this debate.

Keywords: Living donor, hepatocellular carcinoma, alpha-fetoprotein

Liver transplantation (LT) is considered a curative treatment for patients with hepatocellular carcinoma
(HCC) not amenable to surgical resection or ablative curative therapies. HCC was the indication for LT in
[2]
[1]
20.4% of the recipients in the USA in 2018 , 14.4% in Europe and 7.6% and 19% for patients transplanted
[2]
with deceased donors and living donors, respectively, in Japan .
To provide a real chance for these patients to be transplanted with a deceased donor, exception points
(outside the MELD score) have been given all over the world. However, in countries with organ shortage,

© The Author(s) 2020. Open Access This article is licensed under a Creative Commons Attribution 4.0
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