title: High pathological risk of recurrence after surgical resection for hepatocellular carcinoma: an indication for salvage liver transplantation.
abstract: Surgical resection and liver transplantation offer a 5-year survival greater than 70% in patients with hepatocellular carcinoma, but the high recurrence rate impairs long-term outcome after resection. Pathological data such as vascular invasion and detection of additional nodules predict recurrence and divide patients into high and low risk profile. Based on this, we proposed salvage liver transplant to resected patients in whom pathology evidenced high recurrence risk even in the absence of proven residual disease. From January 1995 to August 2003 we have evaluated 1,638 patients. Resection was indicated in 77 patients, but only 17 (22%) (all cirrhotics, 14 hepatitis C virus+) were optimal candidates for both resection and transplantation. Of them, 8 exhibited a high risk profile at pathology and were offered transplantation. Among the 8 high risk patients, 7 presented recurrence, compared with only 2 of the 9 at low risk (P = .012). Two of the high risk patients refused transplant and developed multifocal disease during follow-up. The other 6 were enlisted and all but 1 had tumor foci in the explant. Only 1 presented extrahepatic dissemination early after transplant and died 4 months later. The others are free of disease after a median follow-up of 45 months. Two recurrences were detected in low risk patients, 1 of them being transplanted 18 months after surgery. These data in a small series of patients confirm that pathological parameters identify patients at higher risk of recurrence, which allow them to be listed for liver transplantation without proven malignant disease. In conclusion, this policy is clinically effective and could further improve the outcome of resected patients.
authors.affiliation: Liver Unit, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Hospital Clínic, University of Barcelona, Catalonia, Spain.
authors.forename: Margarita
authors.initials: M
authors.lastname: Sala
authors.forename: Josep
authors.initials: J
authors.lastname: Fuster
authors.forename: Josep M
authors.initials: JM
authors.lastname: Llovet
authors.forename: Miquel
authors.initials: M
authors.lastname: Navasa
authors.forename: Manel
authors.initials: M
authors.lastname: Solé
authors.forename: María
authors.initials: M
authors.lastname: Varela
authors.forename: Fernando
authors.initials: F
authors.lastname: Pons
authors.forename: Antoni
authors.initials: A
authors.lastname: Rimola
authors.forename: Juan Carlos
authors.initials: JC
authors.lastname: García-Valdecasas
authors.forename: Concepció
authors.initials: C
authors.lastname: Brú
authors.forename: Jordi
authors.initials: J
authors.lastname: Bruix
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D018570:Risk Assessment; D012307:Risk Factors; D016879:Salvage Therapy / Q000379:methods*