title: Optimization of liver transplantation as a treatment of intrahepatic hepatocellular carcinoma recurrence after partial liver resection: experience of a single European series.
abstract: BACKGROUND
  The aim of this study was to ascertain the outcome of liver transplantation (LT) due to hepatocellular carcinoma (HCC) in patients who had undergone previous liver resection (LR) for HCC.
  
  
  METHODS
  A case-control study (1:2) was designed to compare patients who underwent LT due to HCC recurrence with a previous LR for HCC (study group) with those who underwent LT for primary HCC but without previous LR (control group).
  
  
  RESULTS
  From January 1990 to December 2007, a total of 303 cirrhotic patients with primary HCC were evaluated for surgery. Primary LT was performed in 191 and LR in 100. When HCC recurrence was diagnosed after LR (69/100), 17 of the 69 (25%) patients underwent LT (study group). The median follow-up was 70 months (12.7-203.0 months). Disease-free survivals at 1, 3, and 5 years in the study group versus the control group were 86%, 68%, 58% vs. 97%, 93%, 89%, respectively (p < 0.04). The 1-, 3-, and 5-year actuarial patient survivals in the study group versus the control group were 59%, 52%, 52% vs. 85%, 76%, 65%, respectively (p = NS). Patients of the study group were divided into two groups according to the time to recurrence after LR: group 1 was <1 year, and group 2 was >1 year. Recurrence after LT was 75% in group 1 vs. 15.4% in group 2 (p < 0.03). The 1-, 3-, and 5-year actuarial patient survivals were 25%, 0%, 0% in group 1 and 69%, 69%, 69% in group 2, p < 0.02).
  
  
  CONCLUSIONS
  Liver transplantation can be safely performed after a previous LR for HCC. Patients with recurrence during the first year after hepatectomy have a poor prognosis after LT.
authors.affiliation: HBP Surgery and Transplantation Department, Hospital Universitario Vall d'Hebron, Universidad Autónoma de Barcelona, Passeig de la Vall d'Hebron 119-129, 08035 Barcelona, Spain. sapisochin@me.com
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Sapisochin
authors.forename: Itxarone
authors.initials: I
authors.lastname: Bilbao
authors.forename: Joaquin
authors.initials: J
authors.lastname: Balsells
authors.forename: Cristina
authors.initials: C
authors.lastname: Dopazo
authors.forename: Mireia
authors.initials: M
authors.lastname: Caralt
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Lázaro
authors.forename: Luis
authors.initials: L
authors.lastname: Castells
authors.forename: Helena
authors.initials: H
authors.lastname: Allende
authors.forename: Ramón
authors.initials: R
authors.lastname: Charco
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006498:Hepatectomy; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000150:complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D016896:Treatment Outcome; D014463:Ultrasonography
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