title: Hepatocellular carcinoma in kidney transplant recipients.
abstract: OBJECTIVE
  A kidney transplant is a suitable surgical management for end-stage renal disease patients; however, posttransplantation malignancy is an unwanted outcome. In Taiwan, hepatocellular carcinoma (HCC) is a major malignancy not only among the general population but also in the post-kidney transplant group. Therefore, regular imaging studies for posttransplantation follow-up are necessary. We examined the imaging characteristics and the efficacy of radiologic diagnostic criteria and the American Joint Committee on Cancer (AJCC) staging system in post-kidney transplantation HCC.
  
  
  METHODS
  We retrospectively reviewed 15 patients with post-transplantation HCC among 554 hospital-based kidney transplant recipients. From 1988 to 2008 we analyzed the patient profiles, imaging studies, histopathologic diagnosis, treatment methods, and outcomes. The 6th-edition AJCC radiologic staging system was applied for validation in this study.
  
  
  RESULTS
  Using the AJCC staging system, all 15 patients with histopathologically confirmed HCC were enrolled as stage I (n=7), stage II (n=2), stage IIIA (n=5), or stage IV (n=1) cases. The 5-year survival rates were 71.4% in stage I, 50% in stage II, 20% in stage IIIA, and 0% in stage IV. Over one-half of post-kidney transplantation HCC were sized 2.5-6.0 cm in diameter with mixed echogenicity. The positive diagnostic rate for radiologic criteria was 83.3%.
  
  
  CONCLUSIONS
  The AJCC staging system and the radiologic diagnostic criteria were validated in post-kidney transplantation HCC. Surgical resection and transcatheter arterial embolization for early-stage HCC in kidney transplant recipients showed satisfactory outcomes. A noncirrhotic liver in a kidney transplant recipient makes surgical resection the treatment of choice because of the better prognosis.
authors.affiliation: Department of Diagnostic Radiology, Chang Gung Memorial Hospital-Kaohsiung Medical Center and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
authors.forename: N-W
authors.initials: NW
authors.lastname: Hsu
authors.forename: F-R
authors.initials: FR
authors.lastname: Chuang
authors.forename: Y-T
authors.initials: YT
authors.lastname: Chen
authors.forename: C-L
authors.initials: CL
authors.lastname: Chen
authors.forename: Y-F
authors.initials: YF
authors.lastname: Cheng
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D005260:Female; D006509:Hepatitis B / Q000150:complications; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality / Q000473:pathology; D008297:Male; D009367:Neoplasm Staging; D012189:Retrospective Studies; D015996:Survival Rate; D014057:Tomography, X-Ray Computed