Liver transplantation for hepatocellular carcinoma in New Zealand: a prospective intent-to-treat analysis.
Liver transplantation (LT) is potentially curative for early hepatocellular carcinoma (HCC) but time spent on the waiting list exposes patients to the risk of tumour progression prior to transplantation.


OBJECTIVE
We prospectively evaluated the outcome for New Zealand patients listed for LT with a pre-transplant diagnosis of HCC.


METHODS
Patients with 1 to 3 tumours, up to 5 cm in diameter, and no vascular invasion or extra-hepatic disease on imaging, were considered eligible for LT. The results were analysed by intention to treat from the time of listing.


RESULTS
Fifty-nine patients were listed with a pre-transplant diagnosis of HCC between February 1998 and June 2004. Ten (17%) were de-listed before LT because of tumour progression, and 9 of 45 (20%) who underwent LT have experienced tumour recurrence up to 59 months post-transplant. For patients listed with a diagnosis of HCC, 5-year actuarial survival was 56.1% from the time of listing. For those listed and transplanted with a diagnosis of HCC, 5-year actuarial survival from the time of transplant was 63.5%. This is significantly worse than the 89.8% 5-year survival for patients transplanted without HCC over the same period (p=0.018) and this difference was entirely due to tumour recurrence.


CONCLUSIONS
37% of patients listed according to our criteria were either de-listed due to tumour progression or experienced recurrence after LT. Based on this experience strategies aimed at preventing waiting list drop out have been adopted, however expansion of tumour-related selection criteria cannot be recommended without a concomitant increase in donor organ availability.
Marui
Yuhji
Y
New Zealand Liver Transplant Unit, Auckland City Hospital, Auckland, New Zealand.
McCall
John
J
Gane
Edward
E
Holden
Andrew
A
Duncan
David
D
Yeong
Mee-Ling
ML
Chow
Kai
K
Munn
Stephen
S
D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology; D009367:Neoplasm Staging; D009520:New Zealand / Q000453:epidemiology; D011446:Prospective Studies; D015996:Survival Rate; D016896:Treatment Outcome