[Hepatocellular carcinoma: impact of waiting list and pre-operative treatment strategies on survival of cadaveric liver transplantation in pre-MELD era in one center in Brazil].
BACKGROUND
Liver transplantation is the main treatment option for hepatocellular carcinoma in patients with cirrhosis.


OBJECTIVE
Three months and 3 years survival were analysed in patients with cirrhosis and hepatocellular carcinoma and in patients with only cirrhosis.


METHODS
Charts of patients subjected to cadaveric liver transplantation at the Clinical Hospital of the Federal University of Paraná, Curitiba, PR, Brazil, between January 5th of 2001 and February 17th of 2006 were reviewed. Patients were divided into two groups for 3 months and 1 year survival analysis: cirrhosis and hepatocellular carcinoma and cirrhosis only. The two groups were also compared in relation to donor and recipient sex and age, etiology of cirrhosis, Child-Pugh and MELD scores at the time of the transplantation, warm isquemia time, cold isquemia time, units of red blood cells transfused during the transplantation, intensive care unit stay and total hospital stay.


RESULTS
One hundred and forty six liver transplantation patients were analysed: 75 were excluded because of incomplete data and 71 were included. General 3 months and 1 year survivals were 77,4% and 74,6% respectively. Patients with hepatocellular carcinoma (n = 12) presented 3 months and 1 year survivals of 100%. These rates were significantly higher than those of patients without hepatocellular carcinoma (n = 59; 72,8% and 69,4%). Mean MELD score, mean Child-Pugh score and mean number of red blood cells transfused were significantly higher in patients without hepatocellular carcinoma. In this group it was also observed more Child-Pugh B and C patients and the diagnosis of cirrhosis because other causes. The rate of Child-Pugh A and hepatitis C was higher in patients with hepatocellular carcinoma. The two groups were identical in all other parameters analysed.


CONCLUSIONS
Patients with cirrhosis and hepatocellular carcinoma presented better 3 months and 1 year survival rates than patients with only cirrhosis. This is possibly due to an early stage of cirrhosis at transplantation of patients with hepatocellular carcinoma.
Freitas
Alexandre Coutinho Teixeira de
AC
Hospital de Clínicas, Universidade Federal do Paraná, Curitiba, PR. alexandrefreitas@ufpr.br
Parolin
Mônica Beatriz
MB
Stadnik
Lucinei
L
Coelho
Júlio Cezar Uili
JC
D000328:Adult; D001938:Brazil; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D011300:Preoperative Care / Q000379:methods; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D014850:Waiting Lists