Tumours and liver transplants

Czech version

Authors: Vladimír Mejzlík; Libuše Husová; Milan Kuman; Soňa Štěpánková; Jiří Ondrášek; Petr Němec
Authors‘ workplace: Centrum kardiovaskulární a transplantační chirurgie Brno, ředitel doc. MUDr. Petr Němec CSc.
Published in: Vnitř Lék 2015; 61(7-8): 738-740
Category: Vanýsek´s day 2015

Overview

Liver transplantation as a curative treatment method can be used for selected primary liver tumours, in particular for hepatocellular carcinoma and rather rare semi-malignant tumours such as epithelioid hemangioendothelioma, further for infiltration of liver by metastatic neuroendocrine tumours (provided that metastases are only located in the liver and the primary tumour was removed) and for benign tumours (hemangiomas and adenomas) with oppression symptoms and size progression. Cholangiocarcinoma is not indicated for liver transplantation at the CKTCH Brno. In recent years liver transplants for hepatocellular carcinoma have increased and hepatocellular carcinoma has also been more frequently found ex post, in the explanted livers. Liver transplantation is indicated in selected patients with a good chance of long-term survival after liver transplantation (a generally accepted limit is 5year survival of 50 % after transplantation). By 20 March 2015 there were liver transplants carried out on 38 patients – in 25 of them was hepatocellular carcinoma diagnosed before transplantation and in 13 it was found in the liver explants. 5year survival following transplantation is reached by 53 % of this cohort. 32 % patients suffered from chronic hepatitis C. The longest surviving (32 years) patient at CKTCH Brno had liver transplanted for a big fibrolamellar hepatocellular carcinoma, which points to the prognostic significance of tumour histology: the criterion only considered in some indication schemes for practical reasons. Benign liver tumours (adenomatosis, cystadenoma, hemangioma with oppression symptoms) are rather rare indications and the transplantation results are favourable. 4 patients underwent transplantation for infiltration of liver by carcinoid, tumour recurrence occurred in one.

Key words:
hepatocellular carcinoma – carcinoid – survival – liver transplant

Sources

1. Data UNOS 2003, 2007. Informace dostupné z WWW: <https://www.unos.org/data/>.

2. Penn I. Hepatic transplantation for primary and metastatic cancers of the liver. Surgery 1991; 110(4): 726–734.

3. Molmenti EP, Klintmalm GB. Liver transplantation in association with hepatocellular carcinoma: An update of the International Tumor Registry. Liver Transpl 2002; 8(9): 736–748.

4. Mazzaferro V, Regalia E, Doci R et al. Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. New Engl J Med 1996; 334(11): 693–699.

5. Mazzaferro V, Llovet JM, Miceli R et al. Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 2009; 10(1): 35–43.

6. Yao FY, Ferrell L, Bass NM et al. Liver transplantation for hepatocellular carcinoma: expansion of the tumor size limits does not adversely impact survival. Hepatology 2001; 33(6): 1394–1403.

7. Venook AP, Ferrell LD, Roberts JP et al. Liver transplantation for hepatocellular carcinoma: Results with preoperative chemoembolization. Liver Transpl Surg 1995; 1(4): 242–248.

8. Decaens T, Roudot-Thoraval F, Bresson-Hadni S et al. Impact of pretransplantation transarterial chemoembolization on survival and recurrence after liver transplantation for hepatocellular carcinoma. Liver Transpl 2005; 11(7): 767–775.

9. Pompilli M, Mirante VG, Rondinara G et al.Percutaneous ablation procedures in cirrhotic patients with hepatocellular carcinoma submitted to liver transplantation: assessment of efficacy at explant analysis and of safety for tumor recurrence. Liver Transpl 2005; 11(9): 1117–1126.

10. Vivarelli M, Cucchetti A, Piscaglia F et al. Analysis of risk factors for tumor recurrence after liver transplantation for hepatocellular carcinoma: Key role of immunosuppression. Liver Transpl 2005; 11(5): 497–503.

11. Kneteman NM, Oberholzer J, Saghier M et al. Sirolimus-based immunosuppression for liver transplantation in the presence of extended criteria for hepatocellular carcinoma. Liver Transpl 2004; 10(10): 1301–1311.