Liver transplantation for hepatocellular carcinoma: the Baylor experience.
BACKGROUND
Liver transplantation (LTX) is indicated in selected patients with hepatocellular carcinoma (HCC) and cirrhosis.


METHODS
We compared the outcome of LTX for patients with and without HCC in 5-year time periods between 1987 and 2007 to reflect the implementation of the Milan tumor selection criteria in 1997 and of the model for end-stage liver disease (MELD) score-based liver allocation in 2002.


RESULTS
Of 2350 patients who underwent primary LTX, 330 had HCC. Five-year patient survival for HCC patients was 28.6% in 1987-1992 and 42.3% in 1992-1997, which was 41.4-31.4% lower than that in non-HCC patients (P < 0.0001). After 1997, 5-year survival was 76% for HCC patients, similar to the survival for non-HCC patients (P = 0.8784). Five-year tumor recurrence dropped from 52.9% (1987-1992) and 48.2% (1992-1997) to 11.4% (1997-2002) and 8.4% (2002-2007) (P < 0.0001). Multivariate analysis for tumor recurrence showed the following significant factors: tumor size >6 cm [hazard ratio (HR) 3.67], >or=5 nodules (HR 3.441), vascular invasion (HR 3.18), transplant in 1987-1992 (HR 6.772), and transplant in 1992-1997 (HR 3.059). MELD-based liver allocation reduced median waiting time for LTX for HCC versus non-HCC (35 vs. 111 days; P = 0.005) without compromise in patient outcome.


CONCLUSIONS
The results of LTX for HCC continue to improve and are equal to results in patients without HCC.
Onaca
Nicholas
N
Baylor Regional Transplant Institute, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA.
Klintmalm
Goran B
GB
D000046:Academic Medical Centers; D001706:Biopsy; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008113:Liver Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000453:epidemiology / Q000473:pathology; D009367:Neoplasm Staging; D015995:Prevalence; D012189:Retrospective Studies; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D014850:Waiting Lists