title: Liver transplantation for hepatocellular carcinoma: the Baylor experience.
abstract: 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.
authors.affiliation: Baylor Regional Transplant Institute, Baylor University Medical Center, 3500 Gaston Avenue, Dallas, TX 75246, USA.
authors.forename: Nicholas
authors.initials: N
authors.lastname: Onaca
authors.forename: Goran B
authors.initials: GB
authors.lastname: Klintmalm
mesh_terms: 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