Orthotopic liver transplantation as a rescue operation for recurrent hepatocellular carcinoma after partial hepatectomy.
OBJECTIVE
To compare post-orthotopic liver transplantation (OLT) survival between patients with recurrent hepatocellular carcinoma (HCC) after partial hepatectomy and those who received de novo OLT for HCC and to assess the risk factors associated with post-OLT mortality.


METHODS
From July 2003 to August 2005, 77 consecutive HCC patients underwent OLT, including 15 patients with recurrent HCC after partial hepatectomy for tumor resection (the rescue OLT group) and 62 patients with de novo OLT for HCC (the de novo OLT group). Thirty-three demographic, clinical, histological, laboratory, intra-operative and post-operative variables were analyzed. Survival was calculated by the Kaplan-Meier method. Univariable and multivariable analyses were also performed.


RESULTS
The median age of the patients was 49.0 years. The median follow-up was 20 mo. Three patients (20.0%) in the rescue OLT group and 15 patients (24.2%) in the de novo OLT group died during the follow-up period (P = 0.73). The 30-day mortality of OLT was 6.7% for the rescue OLT group vs 1.6% for the de novo OLT group (P = 0.27). Cox proportional hazards model showed that pre-OLT hyperbilirubinemia, the requirement of post-OLT transfusion, the size of the tumor, and family history of HCC were significantly associated with a higher hazard for mortality.


CONCLUSIONS
There are no significant differences in survival/mortality rates between OLT as de novo therapy and OLT as a rescue therapy for patients with hcc. Pre-OLT hyperbilirubinemia, post-OLT requirement of transfusion, large tumor size and family history of HCC are associated with a poor survival outcome.
Shao
Zhuo
Z
Department of Biliary Surgery, Eastern Hepatobiliary Surgery Hospital, the Second Military Medical University, Shanghai 200438, China. szlaugh@163.com
Lopez
Rocio
R
Shen
Bo
B
Yang
Guang-Shun
GS
D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000628:therapy; D015331:Cohort Studies; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery* / Q000628:therapy; D016031:Liver Transplantation / Q000379:methods*; D008297:Male; D018895:Microsatellite Repeats; D008875:Middle Aged; D011336:Probability; D012008:Recurrence; D012307:Risk Factors; D016896:Treatment Outcome