Elsevier

Transplantation Proceedings

Volume 38, Issue 7, September 2006, Pages 2121-2122
Transplantation Proceedings

Liver transplantation
Outcome
Outcome of Patients With Recurrent Hepatocellular Carcinoma in Liver Transplantation

https://doi.org/10.1016/j.transproceed.2006.06.030Get rights and content

Abstract

Liver transplantation (OLT) is the treatment of choice for patients with hepatic cirrhosis related hepatocellular carcinoma (HCC). Among 156 liver transplant patients for HCC from June 1996 to February 2005, 23 had recurrent HCC. To evaluate risk factors that affect early recurrence of HCC after OLT, we divided the 23 patients into two groups: early (≤12 months) and late (>12 months) recurrences. Among them, 15 patients were dead and eight alive patients had been followed to 31 July 2005. The most common recurrence site was the grafted liver (n = 15), next was bone (n = 11), lung (n = 8), lymph node (n = 6), brain (n = 4), skin (n = 2), adrenal gland (n = 1). There were no significant differences between the two groups in age or tumor size, number of tumors, cell differentiation, alpha-feto protein levels, tumor staging, number of patients within Milan criteria, steroid pulse therapy, infectious diseases, and immunostaining of tumor. In our study, there were no risk factors that predict early tumor recurrence. We noticed that more patients in the early recurrence group were excluded by Milan criteria due to a more progressed tumor staging with higher mean levels of serum alpha-feto protein.

Section snippets

Patients and methods

Among 156 liver transplant patients for HCC from June 1996 to February 2005, 23 had recurrent HCC. We studied the characteristics of 23 patients divided into two groups, according to the time of recurrence, namely, an early recurrence group (≤12 months) versus a late recurrence group (>12 months). Continuous variables were compared using Student t test and categorical variables using Fisher Exact Test. Statistical analysis was performed using SPSS 11.5 for Windows.

Results

Of 156 adult patients who received OLT for HCC from June 1996 to February 2005, 23 patients (14.7%) showed recurrences. They had received four cadaveric and 19 living donor liver transplantations due to HBV-related liver cirrhosis (n = 19), hepatitis C virus (HCV)-related liver cirrhosis (n = 2), HBV-related hepatitis (n = 1), HCV-related hepatitis (n = 1). The pathological stage according to the 6th AJCC/UICC was stage II in 12; stage IIIA in nine; stage IIIB in one; and stage IIIC in one.

Discussion

Tumor features that predict recurrence and poor prognosis after OLT for HCC include tumor size, number of tumors, micro/macrovascular invasion, high serum alpha-feto protein,1 and Milan criteria, which is one of the well-known predictors. In current studies, it has been suggested that immunostainings of the tumor, including p53, Ki-67,2 p-27, cyclin E, cyclin A,3 and cyclin D14 predict more rapid recurrence and poorer prognosis. In addition to these tumor features, we must consider the role of

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