الفهرس 
Should liver transplantation be beyond UCSF criteria in HCC patients
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Abstract
Background:The advent of tumor size based criteria (Milan and UCSF) for transplantation of Hepatocellular carcinomas (HCC) has facilitated access of tumor patients to transplantation. Recent success in transplanting patients with larger tumors (beyond UCSF) necessitates understanding of patient, tumor and biological criteria that determine successful outcome for HCC Transplantation across all size criteria. Methods: We analyzed 11,928 patients who received deceased donor liver transplants (DDLT) from 2002 till 2013from the UNOS star file. Survival rates were compared by tumor size; Milan (N=11555), beyond Milan within UCSF (N=291) & beyond both Milan & UCSF (N=82). Statistical analysis was done to determine factors impacting survival. We also analyzed 35 patients who received living donor liver transplants (LDLT) in El-Manial hospital in Egypt. Patients were divided into 2 groups, Milan (N=32) & beyond Milan (N=3). We compared survival & recurrence rates between both groups. Results: There were no statistically significant differences in the 1, 3, 4 and 5 year Survival between the three patient groups (within Milan 91.1%, 74.8%, 67.9%, 60.3%, beyond Milan within UCSF 92.7%, 71.1%, 60.3%, 51.6%, beyond both Milan & UCSF 95.8%, 75.9%, 64.7% and 58.1%). In multivariate analysis the hazard ratio and 95% CI of factors significantly affecting survival included, AA race (1.56; 1.37-1.78), AFP >3000 (2.41; 1.77-3.28), Hepatitis C infection (1.45; 1.30-1.62) with age, diabetes and largest tumors diameter having a more modest impact. As regards patients from Egypt, all beyond Milan patients died, while 37.5% of Milan patients died (P=0.036). HCC recurrence rate in Milan patients was 12.5% & in beyond Milan patients was 66.66% (P=0.017)