Background/Aims: Hepatocellular carcinoma (HCC) is one of the major indications for living donor liver transplantation (LDLT). Unlike in deceased donor liver transplantation, however, there exist no universally adopted selection criteria for the potential candidates with HCC in LDLT. Our institutional guideline for HCC in LDLT has been up to 5 nodules with a maximum diameter of 5 cm (5-5 rule). Methods: A total of 78 adult patients underwent adult living donor liver transplantation at University of Tokyo between April 1996 and October 2005. Results: Overall and recurrence-free survival at 5 years after transplantation were 75 and 90%, respectively, with a median follow-up of 2 years. When stratified by the 5-5 rule, recurrence-free survival at 3 years for patients fulfilling the criteria and those exceeding the criteria was 94 and 50%, respectively. Conclusions: In LDLT, the indication for HCC might be expanded from the Milan criteria, with equivalent outcomes. Further study, however, is necessary to justify the general application of the 5-5 rule.

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