LIVING DONOR LIVER TRANSPLANTATION FOR ADVANCED HEPATOCELLULAR CARCINOMA WITH PORTAL VEIN TUMOR THROMBOSIS AFTER CONCURRENT CHEMORADIATION THERAPY

Locally advanced hepatocellular carcinoma (HCC) with portal vein thrombosis carries a 1-year survival rate <10%. Localized concurrent chemoradiotherapy (CCRT), followed by hepatic arterial infusion chemotherapy (HAIC), was recently introduced in this setting. Here, we report our early experience with living donor liver transplantation (LDLT) in such patients after successful down-staging of HCC through CCRT and HAIC. Between December 2011 and December 2017, nineteen patients with locally advanced HCC with portal vein tumor thrombosis (PVTT) at initial diagnosis were given CCRT, followed by HAIC, and underwent LDLT at the Severance Hospital, Seoul, Korea. CCRT [45 Gy over 5 weeks with 5-fluorouracil (5-FU) as HAIC] was followed by HAIC (5-FU/cisplatin combination every 4 weeks for 3–12 months), adjusted for tumor response. . The 1-year overall survival and disease-free survival rate were 90.9% and 87.5%, respectively. The 3-year overall survival and disease-free survival rate were 72.7% and 49.0 %, respectively. There were eight instances of post-transplantation tumor recurrence during follow-up monitoring (median, 46 months; range, 1-72 months) Median survival time from initial diagnosis was 33 months (range 11-110 months). Using an intensive tumor down-staging protocol of CCRT followed by HAIC, LDLT may be a therapeutic option for selected patients with locally advanced HCC and portal vein tumor thrombosis.