title: Liver transplantation in the setting of hepatocellular carcinoma and portal vein thrombosis: a challenging dilemma?
abstract: BACKGROUND
  Portal vein thrombosis (PVT) represents a potentially unfavorable prognostic factor in liver transplantation (LT) for hepatocellular carcinoma (HCC). However, it is frequently difficult to establish preoperatively whether the thrombus is associated with tumor invasion or with stagnant flow. The purpose of this study was to further address this controversial issue.
  
  
  METHODS
  We evaluated 12 consecutive patients who underwent liver transplantation for HCC in the setting of PVT.
  
  
  RESULTS
  The origin of PVT in HCC patients could be accurately evaluated in 58% of the patients. Forty-two percent of patients had no evident portal vein invasion and only 17% of cases had tumor thrombi. One-third of patients experienced tumor recurrence within the first posttransplant year, and one-third of patients became long-term survivors (median survival of 36 months) with no evidence of tumor recurrence. One-year survival was 92%. Nine patients are currently alive after a median follow-up period of 25 months.
  
  
  CONCLUSIONS
  PVT in the setting of HCC is characterized by poor patient outcome. However, a respectable number of instances are not accurately evaluated preoperatively, making the decision to exclude these patients from LT sometimes a challenging dilemma.
authors: Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Hufelandstr. 55, Essen 45122, Germany. Georgios.sotiropoulos@uni-due.de
authors: Georgios C
authors: GC
authors: Sotiropoulos
authors: Arnold
authors: A
authors: Radtke
authors: Klaus J
authors: KJ
authors: Schmitz
authors: Ernesto P
authors: EP
authors: Molmenti
authors: Tobias
authors: T
authors: Schroeder
authors: Fuat H
authors: FH
authors: Saner
authors: Hideo A
authors: HA
authors: Baba
authors: Ioannis
authors: I
authors: Fouzas
authors: Christoph E
authors: CE
authors: Broelsch
authors: Massimo
authors: M
authors: Malagó
authors: Hauke
authors: H
authors: Lang
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000601:surgery*; D005260:Female; D006801:Humans; D008113:Liver Neoplasms / Q000150:complications / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D018579:Patient Selection; D011169:Portal Vein; D011379:Prognosis; D011446:Prospective Studies; D016896:Treatment Outcome; D020246:Venous Thrombosis / Q000209:etiology / Q000601:surgery*