title: Liver transplantation exceeding UCSF criteria: case report of a late recurrence treated by surgery and review of the literature.
abstract: BACKGROUND
  Treatment of a recurrence of hepatocellular carcinoma (HCC) after liver transplantation. Surgery has seldom been considered in such a situation because HCC recurrences are generally considered as a systemic disease.
  
  
  METHODS
  We describe a 47-year-old male patient who underwent liver transplantation in October 1999 for HCC exceeding the Milan and University of California, San Francisco (UCSF), criteria.
  
  
  RESULTS
  In 2007 (8 years after liver transplantation), the patient developed a cervical bone metastasis treated by surgery. In April 2008, HCC had disseminated to hepatic pedicle lymph nodes. An extended hepatic pedicle lymphadenectomy was then performed. Today, our patient is doing well, without signs of recurrence.
  
  
  CONCLUSIONS
  The risk of developing a tumor recurrence is the main argument against expanding the UCSF criteria. In case of an HCC recurrence, various treatments ranging from a change in the immunosuppression regimen to chemotherapy have been proposed. Surgical treatment has rarely been envisaged in the treatment of HCC recurrences because of the technical difficulties and the frequent dissemination of cancer.
authors.affiliation: Department of Surgery, Multivisceral Transplant Center, Hôpital Hautepierre, Louis Pasteur University of Strasbourg, FR-67000 Strasbourg, France. tullio.piardi@chru-strasbourg.fr
authors.forename: T
authors.initials: T
authors.lastname: Piardi
authors.forename: M
authors.initials: M
authors.lastname: Audet
authors.forename: M
authors.initials: M
authors.lastname: Odeh
authors.forename: F
authors.initials: F
authors.lastname: Panaro
authors.forename: M
authors.initials: M
authors.lastname: Cag
authors.forename: J
authors.initials: J
authors.lastname: El-ahmar
authors.forename: G L
authors.initials: GL
authors.lastname: Baiocchi
authors.forename: A
authors.initials: A
authors.lastname: Schneider
authors.forename: P
authors.initials: P
authors.lastname: Wolf
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D008197:Lymph Node Excision; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000601:surgery*