| Liver transplantation (LTx) for HCC is an ideal treatment not only to eliminate HCCs but to replace a damaged liver. In Japan, due to low number of organ donation, most of LTx is performed in living donor transplant (LDLTx) as a final treatment for HCC. To reach the reliable selection criteria, 965 cases of LDLTx were investigated to maximize inclusion cases while ensuring less than 10% of 5-year recurrence and more than 70% of survival rate, and the 5-5-500 criteria was established. Japan criteria (JC; Milan or 5-5-500 criteria) was operated as a national criterion for deceased donor LTx (DDLTx) in 2019, and for LDLTx in 2020. JC was expected to increase the indications of LDLTx. However, HCC cases in LDLTx decreased from 24% to 13.2% in 2020-21. HCC cases in DDLTx changed from 5.2% to 7.1% in 2020-21. Given the facts that the average MELD of Child C is 16, and 72% of DDLTx is performed at the MELD of more than 25, HCC patients would reach the chance one year after registration, because HCC patients receive exceptional 2 points every 3 months. However, its benefit has been limited so far. To rescue more HCC patients with LTx, several factors, such as tumor burden, underling liver damage, and allocation system should be discussed. |
