title: Liver transplantation for hepatocellular carcinoma in clinical practice:  the lesson from a 20-year multicentre experience in Italy.
abstract: BACKGROUND
  Hepatocellular carcinoma (HCC) is an established indication for liver transplantation (LT), but the selection criteria and priority are still debated.
  
  
  OBJECTIVE
  To ascertain the number and features of patients with HCC who undergo transplantation in a Western country, the number of patients eligible for LT according to the American Association for the Study of Liver Diseases (AASLD) guidelines, the number of patients who actually undergo transplantation and whether adherence affects survival.
  
  
  METHODS
  This is a retrospective analysis from a multicentre Italian database of 2042 cases of HCC, recruited prospectively and consecutively. Kaplan-Meier (log rank) and Cox multivariate analysis estimated survival.
  
  
  RESULTS
  Patients who had undergone transplantation (50, 2.5%, with no change over time) had a median survival of 133 months, significantly influenced by the number of lesions and alpha-fetoprotein levels, which were found to be independent predictors of survival on multivariate analysis. Milan criteria were fulfilled in 68%, impacting on survival, whereas 48% fulfilled AASLD guidelines, without such an impact. Two hundred and twenty-eight (11%) patients were eligible for LT according to AASLD; in this group, alpha-fetoprotein levels and Child-Pugh class were independent predictors of survival.
  
  
  CONCLUSIONS
  Among patients with HCC, those undergoing LT represent a small minority; even fewer (1%) are those who undergo transplantation according to AASLD guidelines, adherence to which only marginally affects survival. Overall, LT impact on HCC patients' treatment is very limited.
authors: Department of Surgical and Gastroenterological Sciences, Section of Gastroenterology, University of Padova, Padova, Italy. fabio.farinati@unipd.it
authors: Fabio
authors: F
authors: Farinati
authors: Anna
authors: A
authors: Giacomin
authors: Veronica
authors: V
authors: Vanin
authors: Adriana
authors: A
authors: Sergio
authors: Patrizia
authors: P
authors: Burra
authors: Umberto
authors: U
authors: Cillo
authors: Annamaria
authors: A
authors: Di Nolfo
authors: Paolo
authors: P
authors: Del Poggio
authors: Luisa
authors: L
authors: Benvegnu
authors: Marco
authors: M
authors: Zoli
authors: Franco
authors: F
authors: Borzio
authors: Edoardo G
authors: EG
authors: Giannini
authors: Eugenio
authors: E
authors: Caturelli
authors: Nora
authors: N
authors: Cazzagon
authors: Gian Ludovico
authors: GL
authors: Rapaccini
authors: Franco
authors: F
authors: Trevisani
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D004812:Epidemiologic Methods; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007558:Italy / Q000453:epidemiology; D008113:Liver Neoplasms / Q000175:diagnosis / Q000453:epidemiology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000379:methods / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009363:Neoplasm Proteins / Q000097:blood; D018579:Patient Selection; D017410:Practice Guidelines as Topic; D011379:Prognosis; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
chemical_list: C097353:AFP protein, human; D009363:Neoplasm Proteins; D000509:alpha-Fetoproteins