title: Liver transplantation for hepatocellular carcinoma: our experience from 1986.
abstract: Currently liver transplantation is the treatment of choice for early hepatocellular carcinoma and end-stage liver disease. We analyzed our experience to identify factors that could be used to select patients who will benefit from liver transplantation.
  
  
  METHODS
  From April 1986 to December 2001, 71 (8.7%) of 816 LT performed in our institution, were for patients with hepatocellular carcinoma. In 25 patients the tumor was observed incidental by (35.2%). All patients had liver cirrhosis, most due to hepatitis C related (35) or alcoholic (14) diseases. Before liver transplantation, chemoembolization was performed in 18 patients (25.4%).
  
  
  RESULTS
  Bilateral involvement was present in seven patients. Eight patients showed macroscopic vascular invasion, and eight others showed satellite nodules. Most patients were stage TNM II (29) and IVa (16). Overall 1-, 3-, and 5-year survival were 79.3%, 61%, and 50.3% with recurrence-free survivals of 74.6%, 57.5%, and 49%, respectively. With a mean follow-up of 42 months, 12 patients (19%) developed recurrence and 29 patients died (only 11 due to recurrence). Stage TNM IVa, macroscopic vascular invasion, and the presence of satellite nodules significantly affected overall survival and recurrence-free survival rates and histologic differentiation and bilateral involvement only recurrence-free survival. Patients with solitary tumors less than 5 cm or no more than three nodules smaller than 3 cm showed better recurrence-free survival and lower recurrence rates.
  
  
  CONCLUSIONS
  In our experience, liver transplantation proffers good recurrence-free survival and low recurrence rates among patients with limited tumor extension. The most important prognostic factor was macroscopic vascular invasion.
authors.affiliation: Department of Surgery, Hospital 12 de Octubre, Madrid, Spain.
authors.forename: B
authors.initials: B
authors.lastname: Pérez Saborido
authors.forename: C
authors.initials: C
authors.lastname: Loinaz Segurola
authors.forename: A
authors.initials: A
authors.lastname: Gimeno Calvo
authors.forename: J C
authors.initials: JC
authors.lastname: Meneu Díaz
authors.forename: M
authors.initials: M
authors.lastname: Abradelo de Usera
authors.forename: J
authors.initials: J
authors.lastname: Calvo Pulido
authors.forename: C
authors.initials: C
authors.lastname: Jiménez Romero
authors.forename: R
authors.initials: R
authors.lastname: Gómez Sanz
authors.forename: I
authors.initials: I
authors.lastname: García García
authors.forename: E
authors.initials: E
authors.lastname: Moreno González
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D012189:Retrospective Studies