Optimization of liver transplantation as a treatment of intrahepatic hepatocellular carcinoma recurrence after partial liver resection: experience of a single European series.
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.
Sapisochin
Gonzalo
G
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
Bilbao
Itxarone
I
Balsells
Joaquin
J
Dopazo
Cristina
C
Caralt
Mireia
M
Lázaro
Jose Luis
JL
Castells
Luis
L
Allende
Helena
H
Charco
Ramón
R
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
Ann Surg. 1999 Mar;229(3):322-30
10077043
World J Surg. 2002 Feb;26(2):257-63
11865357
J Hepatol. 2003 Feb;38(2):200-7
12547409
Ann Surg. 2003 Dec;238(6):885-92; discussion 892-3
14631225
Semin Liver Dis. 2005;25(2):181-200
15918147
Br J Surg. 1996 Jun;83(6):758-61
8696732
Ann Ital Chir. 2008 Mar-Apr;79(2):111-5
18727273
Hepatol Res. 2003 Jun;26(2):142-147
12809942
Liver Transpl. 2005 Oct;11(10):1242-51
16184539
Transpl Int. 2005 Mar;18(3):278-82
15730486
Ann Surg Oncol. 2005 May;12(5):364-73
15915370
Hepatology. 2005 Nov;42(5):1208-36
16250051
Hepatology. 1999 Dec;30(6):1434-40
10573522
Cancer. 2004 Aug 15;101(4):796-802
15305412
Ann Surg. 2003 Oct;238(4):508-18; discussion 518-9
14530722
Ann Surg. 1998 Oct;228(4):479-90
9790338
Ann Surg. 2003 Nov;238(5):703-10
14578733
Nat Rev Cancer. 2006 Sep;6(9):674-87
16929323
Semin Liver Dis. 1999;19(3):329-38
10518312
Ann Surg. 1999 Jun;229(6):790-9; discussion 799-800
10363892
Ann Surg. 2004 Feb;239(2):150-9
14745321
Semin Liver Dis. 2005;25(2):143-54
15918143
N Engl J Med. 1996 Mar 14;334(11):693-9
8594428
Am J Transplant. 2007 Aug;7(8):1875-81
17532747
J Hepatol. 2008;48 Suppl 1:S20-37
18304676
Arch Surg. 2001 Jan;136(1):25-30; discussion 31
11146770
Hepatology. 2001 May;33(5):1080-6
11343235
N Engl J Med. 2008 Nov 6;359(19):1995-2004
18923165
Ann Surg. 2002 Mar;235(3):373-82
11882759
Hepatology. 2006 Mar;43(3):515-24
16496320
Gastroenterology. 2004 Nov;127(5 Suppl 1):S261-7
15508092
Liver Transpl. 2004 Oct;10(10):1294-300
15376311