Retrospective Study
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World J Gastroenterol. Jun 7, 2014; 20(21): 6594-6601
Published online Jun 7, 2014. doi: 10.3748/wjg.v20.i21.6594
Inflammatory markers as selection criteria of hepatocellular carcinoma in living-donor liver transplantation
Gun Hyung Na, Dong Goo Kim, Jae hyun Han, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You
Gun Hyung Na, Dong Goo Kim, Jae hyun Han, Eun Young Kim, Soo Ho Lee, Tae Ho Hong, Young Kyoung You, Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, Seoul 137-701, South Korea
Author contributions: Na GH designed study, performed study, collected data, analyzed data, and wrote the paper; Kim DG designed study, performed study, analyzed data; Han JH, Kim EY and Lee SH collected data; Hong TH and You YK designed study.
Correspondence to: Dong Goo Kim, MD, PhD, Professor of Surgery, Department of Surgery, Seoul St. Mary’s Hospital, The Catholic University of Korea, 505 Banpo-dong, Seocho-gu, Seoul 137-701, South Korea. kimdg@catholic.ac.kr
Telephone: +82-2-22586096 Fax: +82-2-5952822
Received: December 31, 2013
Revised: February 17, 2014
Accepted: March 7, 2014
Published online: June 7, 2014
Processing time: 157 Days and 3.6 Hours
Abstract

AIM: To investigate that inflammatory markers can predict accurately the prognosis of hepatocelluar carcinoma (HCC) patients in living-donor liver transplantation (LDLT).

METHODS: From October 2000 to November 2011, 224 patients who underwent living donor liver transplantation for HCC at our institution were enrolled in this study. We analyzed disease-free survival (DFS) and overall survival (OS) after LT in patients with HCC and designed a new score model using pretransplant neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP).

RESULTS: The DFS and OS in patients with an NLR level ≥ 6.0 or CRP level ≥ 1.0 were significantly worse than those of patients with an NLR level < 6.0 or CRP level < 1.0 (P = 0.049, P = 0.003 for NLR and P = 0.010, P < 0.001 for CRP, respectively). Using a new score model using the pretransplant NLR and CRP, we can differentiate HCC patients beyond the Milan criteria with a good prognosis from those with a poor prognosis.

CONCLUSION: Combined with the Milan criteria, new score model using NLR and CRP represent new selection criteria for LDLT candidates with HCC, especially beyond the Milan criteria.

Keywords: C-reactive protein; Hepatocellular carcinoma; Liver transplantation; Neutrophil-lymphocyte ratio; Selection criteria

Core tip: Although the Milan criteria are accepted as the standard selection criteria for liver transplantation candidates with hepatocelluar carcinoma (HCC), they are so strict; New selection criteria are needed to predict more accurately the prognosis of patients with HCC; Using a new score model using pretransplant neutrophil-lymphocyte ratio (NLR) and C-reactive protein (CRP), we can differentiate HCC patients beyond the Milan criteria with a good prognosis from those with a poor prognosis; Combined with the Milan criteria, a new score model using pretransplant NLR and CRP may represent new selection criteria for living-donor liver transplantation candidates with HCC, especially beyond the Milan criteria.