Hepatic transplantation for primary and metastatic cancers of the liver.
Long-term results of transplantation for primary and metastatic hepatic malignancies were evaluated retrospectively in 637 patients. Recurrence rates and 2-year and 5-year patient survival rates were calculated. The overall recurrence rate was 40%, with 81% of deaths from recurrence occurring within 2 years after transplantation. Best results were obtained with uncommon tumors: incidental hepatomas (13% recurrence; 57% 2-year and 5-year follow-up); epithelioid hemangioendotheliomas (33% recurrence; 82% and 43% 2-year and 5-year survival); hepatoblastomas (33% recurrence; 50% 2-year and 5-year survival); and fibrolamellar hepatomas (39% recurrence; 60% and 55% 2-year and 5-year survival). Hemangiosarcomas had 64% recurrence, and all patients died within 27.5 months. Tumors metastatic to the liver had 59% recurrence, with 38% and 21% 2-year and 5-year survival rates. Transplantation should be abandoned for hemangiosarcomas and most metastatic tumors, except possibly for some slowly growing neuroendocrine tumors. The usual hepatomas had 39% recurrence with 2-year and 5-year survival rates of 30% and 18%, respectively. Cholangiocarcinomas had 44% recurrences with 2-year and 5-year survival rates of 30% and 17%, respectively. Transplantation for hepatomas and cholangiocarcinomas should be reserved for patients with favorable risk factors or when combined with well-defined chemotherapy protocols before and after operation.
Penn
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Department of Surgery, University of Cincinnati Medical Center, Ohio 45267-0558.
D002759:Adenoma, Bile Duct / Q000556:secondary / Q000601:surgery*; D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000556:secondary / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006394:Hemangiosarcoma / Q000556:secondary / Q000601:surgery*; D006801:Humans; D007223:Infant; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009382:Neoplasms, Unknown Primary