471 THE IMPACT OF ISCHEMIA/REPERFUSION IN DECEASED AFTER CARDIAC DEATH DONOR LIVERS

Results: Overall, 160 (41.5%) patients achieved successful downstaging of HCC to within the Milan criteria. During the follow-up, 82 eventually dropped off the waiting list for LT due to tumor progression, with estimated dropout rates at 1, 2, and 5 years of 46.7%, 70.2%, and 84.6%, respectively. Thirty-seven patients ultimately underwent LT. The overall post-transplant survival rates at 1, 2, and 5 years were 89.2%, 70.3%, and 54.6%, while the corresponding rates for recurrence-free survival were 74.7%, 71.8%, and 66.3%, respectively. Multivariate analysis indentified alpha-fetoprotein (AFP) levels 100 ng/ml at LT (P = 0.003), maximum tumor size 7 cm (P = 0.002), and the lack of complete necrosis by TACL (P = 0.048) as independent predictors of HCC recurrence after LT. Patients with none of these risk factors had an excellent post-transplant outcome, with an 87.5% probability of recurrence-free survival up to 6 years. Conclusions: These long-term results may contribute to the database for optimizing management of LT candidates with downstaged HCC. Although overall outcome of downstaged patients falls short of that of those initially meeting the Milan criteria, carefully selected patients can have long-term survival post-LT. Based on our data, patients with a maximum tumor size <7 cm who achieve complete necrosis together with AFP levels <100 ng/ml at LT may be the best candidates for LT following downstaging using TACL.