Antiviral prophylaxis and recurrence of hepatocellular carcinoma following liver transplantation in patients with hepatitis B.
BACKGROUND
Orthotopic liver transplantation (OLT) is a viable treatment option for patients with hepatitis B (HBV) and concomitant hepatocellular carcinoma (HCC). However, cancer recurrence following transplantation approaches 20%. This study sought to identify the clinical and pathological factors associated with post-OLT survival.


METHODS
Univariate and multivariate analyses considered the following variables: combination viral prophylaxis, HBV recurrence, tumor stage, vascular invasion, distribution, nodularity, pre- and post-OLT tumor size, pre-OLT alpha-fetoprotein (AFP), Milan and UCSF criteria, and Asian race.


RESULTS
Cumulatively, HCC recurrence-free survival was 77%, 62%, and 53% at 1, 3, and 5 years, respectively, and was significantly better in patients who were free of viral recurrence post-OLT. Similarly, patients treated with combination prophylaxis had a significantly lower mortality than those who were not.


CONCLUSIONS
Multivariate analysis revealed that AFP>500 ng/mL, presence of vascular invasion by explant, HBV recurrence, and combination prophylaxis were independent predictors of HCC recurrence-free survival.
Zimmerman
M A
MA
Department of Surgery, Division of Liver and Pancreas Transplantation, The Pfleger Liver Institute, The Dumont-UCLA Transplant Center, The David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California 90095-7054, USA.
Ghobrial
R M
RM
Tong
M J
MJ
Hiatt
J R
JR
Cameron
A M
AM
Busuttil
R W
RW
D000704:Analysis of Variance; D000998:Antiviral Agents / Q000627:therapeutic use*; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000401:mortality / Q000601:surgery*; D018572:Disease-Free Survival; D006509:Hepatitis B / Q000150:complications* / Q000188:drug therapy / Q000601:surgery; D006801:Humans; D007136:Immunoglobulins / Q000627:therapeutic use; D019259:Lamivudine / Q000627:therapeutic use; D008113:Liver Neoplasms / Q000150:complications / Q000401:mortality / Q000601:surgery; D009367:Neoplasm Staging; D011183:Postoperative Complications / Q000517:prevention & control / Q000821:virology; D012008:Recurrence; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors; D013997:Time Factors; D014777:Virus Diseases / Q000453:epidemiology / Q000517:prevention & control*
D000998:Antiviral Agents; D007136:Immunoglobulins; D019259:Lamivudine; C045213:hepatitis B hyperimmune globulin