Abstract:
INTRODUCTION:Orthotopic liver transplantation (OLT) is an excellent option for patients with unresectable hepatocellular carcinoma (HCC) within the Milan criteria. Recurrence of HCC has a severe impact on post-OLT survival. In this study, we performed an analysis of post-OLT recurrence pattern of HCC. METHODS:The prospective cohort of OLT patients included those with unresectable HCC within the Milan criteria, and those beyond the Milan criteria who were downstaged with transcatheter arterial embolization until they achieved the Milan criteria. RESULTS:Between May 2006 and May 2011, we performed 130 OLT for unresectable HCC within the Milan Criteria among whom 9 patients (6.9%) experienced tumor recurrence. Two (22.2%) had undergone preoperative downstaging. At the time of OLT, mean serum alpha-fetoprotein levels were 623.8 ± 682.9 ng/mL. The liver explants showed 7 (77.8%) subjects were within the Milan criteria, with an average 2.6 ± 2.2 tumors, most of which (89%) were moderately differentiated. Microvascular and macrovascular invasion were observed in 5 (55.6%) and 2 (22.2%) cases, respectively. Liver explants were beyond the Milan criteria in both patients who had undergone preoperative downstaging. Recurrence occurred 23.1 ± 14.3 months after OLT, having been detected in the liver (n = 3; 33.3%), lung (n = 3; 33.3%), brain, peritoneum, and adrenal gland (n = 1 each; 11.1% each). Mean survival after detection of recurrence was 137.4 ± 96.4 days. CONCLUSIONS:Despite strict candidate selection criteria, HCC recurrence may occur after OLT, bearing a significant impact on posttransplant outcomes to optimize results requires refinements in candidate selection, as well as well-defined cost-effective post-OLT surveillance protocols.
journal_name
Transplant Procjournal_title
Transplantation proceedingsauthors
Felga G,Evangelista AS,Salvalaggio PR,Curvelo LA,Della Guardia B,Almeida MD,Afonso RC,Ferraz-Neto BHdoi
10.1016/j.transproceed.2012.07.004subject
Has Abstractpub_date
2012-10-01 00:00:00pages
2459-61issue
8eissn
0041-1345issn
1873-2623pii
S0041-1345(12)00700-2journal_volume
44pub_type
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pub_type: 临床试验,杂志文章
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pub_type: 杂志文章,评审
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journal_title:Transplantation proceedings
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pub_type: 临床试验,杂志文章
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更新日期:2017-04-01 00:00:00
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