26 A multicenter study from

49 transplantation centers in Japan including 653 patients with HCC who received LDLT proposed new selection criteria using three variables: within the MC; low serum AFP (≤ 400 ng/mL); and low DCP (≤ 100 mAU/mL).27 Surprisingly, the 5-year disease-free survival rate among the 208 patients who met these new criteria was 99.5%. The experience of LDLT under expanded criteria from the start of LDLT for HCC could lead to the establishment of new “adequate” selection criteria. Interestingly, the inclusion of tumor markers as well as morphological parameters now appears prerequisite to the establishment of optimal criteria for both DDLT and LDLT. Cold ischemic time is

undoubtedly shorter in LDLT than in DDLT. Prolonged CIT is closely related to the occurrence of various complications, Z-VAD-FMK molecular weight including ACR and graft loss after DDLT.2,3 In theory, shorter CIT in LDLT would reduce the incidence of such unfavorable complications. However, Shaked et al. reported that the incidence of ACR and graft loss did not differ between LDLT and DDLT.2 The risk of ACR for LDLT with a CIT of 50 min is similar to that for DDLT with a CIT of 380 min, although longer CIT was associated with increased risk of rejection in both types TSA HDAC of transplantation. This finding suggests that living Urocanase donor allografts are much more susceptible to prolonged cold ischemia than deceased donor allografts. Immunological molecules activated in the immediately early regenerative process shown in the living donor allograft may unfavorably affect the occurrence of ACR in LDLT. Selzner et al. most recently compared outcomes between adult-to-adult LDLT recipients with graft-to-body

weight ratio < 0.8, LDLT recipients with graft-to-body weight ratio ≥0.8, and matched DDLT recipients.28 Although LDLT recipients showed a significantly shorter CIT than DDLT recipients, no differences in either graft survival or patient survival were seen between the three graft types. A large comparative study in the United States of 764 patients who received LDLT and 1470 matched DDLT recipients showed significantly lower graft survival in LDLT recipients than in DDLT recipients (2-year graft survival, 64.4% vs 73.3%, P < 0.001) despite significantly shorter CIT time in LDLT recipients.29 Both patient survival and graft survival are affected by various factors, such as preoperative recipient conditions and intra- and postoperative factors. Shorter CIT in LDLT would not show advantages in terms of graft survival.