Studies supported the safe application of the same criteria (Milan criteria and the University of California, San Francisco [UCSF] criteria10) to select patients with HCC for LDLT.11 In their studies based on the Markov model, Cheng et al.12 and Sarasin et al.13 also showed that LDLT could confer a substantial survival advantage for patients with compensated cirrhosis and nonresectable early stage HCC, and may especially be warranted if the waiting time for a deceased donor buy INK 128 liver graft was expected to exceed 7 months. This is indeed the case in most of the patients with HCC listed for LT today. In

the United States, approximately 7,000 new patients with HCC are put on the waiting list for LT every year,14 10% to 15% of whom die during the waiting period.15 In Europe and the United States, the dropout rate at various centers ranges between 15% and 35%.16, 17 Although the use of adult-to-adult LDLT may shorten waiting time, decrease mortality on the waiting list,13,

AZD1208 in vitro 18 and reduce cold ischemia time, thus improving the short-term results of LT via optimal graft function, questions regarding the implications of the type of graft on the disease process and outcome have been raised.19, 20 The potential risks of LDLT for HCC include fast-tracking to transplantation with the risk of more tumor recurrences post-transplantation,21, 22 the risk of a less optimal cancer surgery due to technical constraints, and the rapid regeneration that occurs in the immediate post LDLT period, which could provide an ideal milieu for cancer progression in these patients, which in turn could lead to early23, 24 or multiple-site recurrence. Some multicenter and few single-center studies have compared the results of LDLT with deceased donor liver transplantation (DDLT) for HCC. However, none of these studies was performed on an intention-to-treat strategy. The primary goal of our study was to analyze, on an intention-to-treat basis, whether Ribose-5-phosphate isomerase LDLT performed as well as DDLT

in patients with HCC with regard to long-term outcomes. We chose recurrence rate as the primary endpoint of our study, because recurrence is the most important factor determining long-term outcome and is responsible for late deaths after LT. AFP, alpha-fetoprotein; DDLT, deceased donor liver transplantation; DFS, disease-free survival; HCC, hepatocellular carcinoma; LDLT, living donor liver transplantation; LT, liver transplantation; OS, overall survival; UCSF, University of California, San Francisco; UNOS, United Network of Organ Sharing. From March 2000 to November 2009, 183 adult patients with HCC with cirrhosis were listed for LT at our center (Centre Hepatobiliaire, Paul Brousse Hospital, Villejuif, France). During this period, a total of 95 LDLTs and 960 DDLTs were performed. The cohort of 183 consecutive patients included only those who were diagnosed to have HCC preoperatively, either histologically proven or as defined by Barcelona criteria.