Mohamed. Fathy, Dabous H and M. Metieni
Ain Shams University, Egypt
Scientific Tracks Abstracts: J Clin Gastroenterol Hepatol
Introduction : Living donor liver transplantation (LDLT) for HCC in cirrhotic patients has emerged as a rewarding therapy for a cure and a successful alternative in countries where a DDLT program is lacking. Several investigators have reported variable expanded criteria for liver transplantation beyond Milan Criteria. In this study, we aim to point out the impact of expanding criteria beyond Milan on tumor recurrence and patient survival. Patients and methods: Retrospective study of prospectively collected data of the 211 patients, with pre-transplant diagnosis of HCC, was done including pre-transplant, operative and post-transplant data. This patient cohort was divided according to the pre-transplant radiological findings of HCC nodules number and sizes into 3 groups; Group I: comprised 149 (70%) patients who fall within the Milan criteria; Group II: included 33 (15.6%) patients who fall within up-to-7 criteria and; Group III: including 29 (13.7%) cases all being beyond up-to-7 criteria and will be termed beyond all criteria (BAC).Results 149(70%) recipients were within Milan(group 1), 33 (15.6%) recipients had tumor size or nodules up to 7(group 2),29(13.7%) were beyond all criteria(group 3). Locoregional therapy in the form of bridging in group 1 or downstaging in group 2 or 3 was done. Thirty one patients (14.6%) had HCC recurrence, 19 patients within the Milan criteria, 7 recipients up to seven and 5 beyond all with mean time to recurrence 15.6 months. The Overall survival for all patients was 87%, 72%, 65% for 1, 3, 5 years respectively and recurrence free survival was 96%, 87%, 80%. There was no difference regarding the recurrence rate among different groups with no intra or postoperative mortality among donors. In conclusion; careful selection of recipients beyond Milan with proper bridging and downstaging may offer better overall and recurrence free survival after LDLT.
Mohamed Fathy is a professor of hepatobiliary surgery and liver transplantation in Ain shams university, Cairo, Egypt. In 2000 he got his MD degree in general surgery. in 2001-2002 he started his training career in The department of the General surgery & Organ transplantation in Essen University, Germany where he actively involved (with a license from the German ministry of health as a registered doctor) in Different organ transplantation and Advanced biliary and pancreatic surgery. In 2002 he shared in living donor liver transplantation program in Wady EL Nile hospital followed by Egypt air center for organ transplantation in 2007 and Ain shams university center for organ transplantation 2008. He performed more than 1200 case of LDLT making his team one of the most experience team in that field. In 2018 he became the Dean of National institute for liver disease, Cairo Egypt. He has a lot of publications including some modification in the technique in LDLT.
E-mail: mfghaffar@hotmail.com
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