The new strategy of treatment for unresectable hepatocellular carcinoma in living related donor liver transplantation

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Major problem of liver transplantation for hepatocellular carcinoma (HCC) is tumor recurrence. Most of reason for tumor relaps are dissemination of cancer cells from the native liver to systemic circulation and immunosuppressants. Detection of circulating cancer cells has been performed by polymerase chain reaction of h-TERT mRNA, however, its clinical significance is still unclear. Therefore we investigated about the relations tumor recurrence and h-TERT mRNA expression in peripheral blood in the patients underwent living related donor liver transplantation (LRDLT) with preoperative immunochemotherapy We investigated the neoadjuvant immunochemotherapy (5FU+adriamycin+Interferon β(IFNβ)) and adjuvant chemotherapy with systemic administration of 10mg of adriamycin once a week and intraportal treatment with 250mg of 5FU for three consecutive days, which we called "Sandwich chemotherapy", was started as a single course on day 7 after LRDLT. FK506 and prednisolone were used as immunosuppre … More ssants following LRDLT. Transfer of donor blood via the portal vein was started immediately after the reconstruction of hepatic artery. Transfusion of 50 ml or 100 ml of donor blood via the portal vein was performed almost once a week starting on day 1.Eight times of inoculation of donor specific transfusion (DST) via portal vain were performed after LRDLT. this regimen might reduce the preoperative circulating cancer cells and prevent the postperative micrometastasis to the graft graft liver. Moreover, intra-and postoperative administration of DST via the portal vein brought rapid reduction of immunosupressants in the present clinical case. These results may be glad tidings in terms of expanding the indications for unresectable advanced HCC and may introduce an additional solution to transplantation immunology. Prognosis of liver transplantation for HCC patients deviated from Milan Criteria might be poor in spite of adjuvant immunochemotherapy. however, if circulating cancer cells are eliminated by adjuvant immunochemotheray, liver transplantation may be effective even for unresectable HCC deviated from Milan Criteria. Less