open access

https://hdl.handle.net/2115/97497

Potential indications for liver transplant in Child-Pugh A and Model for End-stage Liver Disease exception for hepatocellular carcinoma in Japan

英語

Child-Pugh

2025-03-03

John Wiley & Sons

Hepatology Research

55(6)

896-907

Aim In 2019, expanded criteria for hepatocellular carcinoma (HCC), known as 5-5-500 (size <= 5 cm, number <= 5, alpha-fetoprotein <= 500 ng/mL), as well as Model for End-stage Liver Disease (MELD) exception, were implemented in Japan. In the present study, we evaluated liver transplantation indications and the Japanese allocation policy for HCC. Methods Adults with HCC were evaluated between January 2013 and December 2017 in a multicenter study in Japan. The patients were aged <= 65 years, in line with the limits of Japanese transplant center limits. Results HCC patients (n = 289) were classified as Child-Pugh A (74%), B (18%), or C (8%). Of these, 178 (62%) and 185 (64%) met the Milan and 5-5-500 criteria, respectively. The respective 1- and 5-year overall survival rates of patients who met the criteria were 100% and 88.1% in Child-Pugh A, 91.7% and 30.6% in B, and 72.9% and 0% in C without access to liver transplantation. For Child-Pugh A patients, we developed a risk score using the Child-Pugh score, des-gamma-carboxy prothrombin, tumor-node-metastasis stage grade, as well as albumin-bilirubin and albumin-bilirubin tumor-node-metastasis stage , which predicted worse prognosis. Additionally, we showed the characteristics of patients who achieved MELD exception points high enough to receive an organ: survival at least 2 years after waitlist registration, relatively good liver functional reserve, and sufficient tumor control with multiple treatments. Conclusions High-risk patients, identified by our scoring system and albumin-bilirubin tumor-node-metastasis stage >= 2 in Child-Pugh A, should be considered for liver transplantation eligibility. The allocation policy for HCC should be revised based on precise evaluations on a regular basis.

学術雑誌論文

Accepted Manuscript

This is the peer reviewed version of the following article: Goto R, Shimamura T, Nakajima T, Ogawa K, Tanaka K, Shimizu T, et al. Potential indications for liver transplant in Child–Pugh A and Model for End-stage Liver Disease exception for hepatocellular carcinoma in Japan. Hepatol Res. 2025; 55(6): 896–907, which has been published in final form at https://doi.org/10.1111/hepr.14178. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.

1386-6346

1872-034X