Liver transplantation for hepatocellular carcinoma, long-term outcomes and risk factors of tumour recurrence (single-centre experience)

Czech version

Authors: R. Šenkeříková ¹; S. Fraňková ¹; J. Šperl ¹; M. Oliverius ²; J. Froněk ²; E. Kieslichová ³; H. Filipová ⁴; D. Kautznerová ⁴; E. Honsová ⁵; P. Trunečka ⁶; J. Špičák ¹
Authors‘ workplace: Klinika hepatogastroenterologie, IKEM, Praha ¹; Klinika transplantační chirurgie, IKEM, Praha ²; Klinika anesteziologie, resuscitace a intenzivní péče, IKEM, Praha ³; Pracoviště radiodiagnostiky a intervenční radiologie, IKEM, Praha ⁴; Pracoviště klinické a transplantační patologie, IKEM, Praha ⁵; Transplantcentrum, IKEM, Praha ⁶
Published in: Gastroent Hepatol 2014; 68(2): 139-145
Category: Hepatology: Original Article

Overview

Background and aims:
Liver transplantation (OLT) is currently the treatment of choice for hepatocellular carcinoma (HCC) in cirrhotic liver, because it removes the tumour as well as the cirrhotic tissue with malignant potential. However, OLT improves survival especially in patients with a small tumour, who have a low risk of tumour recurrence after OLT. The aim of our study was to retrospectively analyse survival of patients who underwent liver transplantation for HCC in our centre and to identify the risk factors of tumour recurrence after OLT.

Patient characteristics:
Eighty-one adult patients who underwent liver transplantation in our centre for HCC (HCC group) were enrolled into the study. They all complied with the extended indication criteria (HCC < 6.5 cm) and 61/81 also met the Milan criteria (HCC < 5 cm). The control group consisted of 606 patients transplanted for end-stage liver disease without evidence of tumour (Ci group) within the same period.

Results:
1-, 3- and 5-year overall survival was worse in HCC patients compared with the Ci group (HCC 77%, 70% and 66% vs Ci 93%, 90% and 87%, p < 0.001). Long-term survival is comparable with foreign transplant centres in the Metroticket Group (5-year survival 71.2% and 10-year survival 58.4% if the extended criteria are met). 13/81 (16%) patients experienced HCC recurrence, and the median time to recurrence after OLT was 182 days (101–2322).

Conclusions:
Higher AFP value before OLT, the largest node size and proved angioinvasion represented the independent predictive factors of tumour recurrence. To achieve even better results, regular screening of risk groups of cirrhotic patients resulting in detection of small tumours and their early referral to OLT is crucial.

Key words:
liver transplantation – hepatocellular carcinoma – recurrence – survival – cirrhosis

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manuscript met the ICMJE „uniform requirements“ for biomedical papers.

Submitted:
6. 3. 2014

Accepted:
7. 4. 2014

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