Living related liver transplantation for hepatocellular carcinoma in Egypt.
BACKGROUND
Living related liver transplantation (LRLT) for hepatocellular carcinoma (HCC) in cirrhotic patients has emerged as a rewarding therapy for a cure. Extensions of the Milan criteria have been proposed with encouraging results.


METHODS
From October 2001 to June 2004, 47 adult patients with end-stage liver disease (ESLD) have been treated using LRLT, including 11 (9 males and 2 females) with HCC superimposed on hepatitis C virus (HCV)-related (n = 10) or hepatitis B virus-related (n = 1) cirrhosis. Their mean age was 50 years (range, 40-61). HCC was confirmed preoperatively in 9 subjects whereas it was an incidental finding in 2 cases. Alpha fetoprotein (AFP) levels were elevated in 5 of them. Radiologically, tumor number and sizes ranged from 1 to 2 nodules and from 1.5 to 7 cm, respectively. Five of the 11 subjects underwent pretransplantation tumor control therapy.


RESULTS
Nine patients are alive, all of them being disease free during follow-up periods ranging from 6 to 30 months. Two subjects died: one of HCC recurrence at 1 year posttransplantation, and another of a pulmonary embolism on day 7. AFP levels decreased to normal values in 4 cases. Excluding the 2 incidental tumors, pathological examination of the explants revealed a higher number and larger size of the nodules in 3 and 5 cases, respectively. Microvascular invasion was documented in 3 explants, 1 of which experienced HCC recurrence and the other 2 received 6 cycles of Doxorubicin following normalization of their liver profile. Postoperative complications included the following: recurrent HCC (n = 1), recurrent HCV (n = 2), acute cellular rejection (n = 3), anastomotic biliary stricture (n = 1), and subphrenic collection (n = 1).


CONCLUSIONS
Our current data confirm the efficacy of LRLT for treatment of HCC superimposed on liver cirrhosis.
El-Meteini
M
M
Liver Transplant Unit, Wady EL-Neel Hospital, Cairo, Egypt. mmeteini@idsc.net.eg
Fayez
A
A
Fathy
M
M
Abdalaal
A
A
Safaan
H
H
Mostafa
I
I
Abdalaal
M
M
Mokhtar
A
A
Salah
M
M
El-Dorry
A
A
Abdalwahab
S
S
El-Monayeri
M
M
Boillot
O
O
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D004534:Egypt; D005190:Family; D005260:Female; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods* / Q000401:mortality / Q000502:physiology; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000145:classification; D012189:Retrospective Studies; D016019:Survival Analysis