Hepatic hemangiosarcoma: an absolute contraindication to liver transplantation--the European Liver Transplant Registry experience.
BACKGROUND
Liver transplantation (LT) is performed for hemangiosarcoma (HAS) despite disappointing results.


METHODS
Retrospective study of 14 males and 8 females reported to the European Liver Transplant Registry. In view of the difficult differential diagnosis between HAS and hemangioendothelioma (HE), the study was deliberately restricted to the period 1986 to 2004 to allow comparison of clinical and biochemical behavior of HAS and HE liver recipients transplanted during the same time period.


RESULTS
Clinical signs, symptoms, and biochemical parameters differed significantly. Pre-LT diagnosis of HAS was made in only 5 of 16 (31%) biopsied patients. HE (7 patients) and hepatocellular cancer (2 patients) were confounding diagnoses leading to LT. Extrahepatic disease was present at time of LT in 4 (19%) patients. Giant invalidating tumor (5 HAS, 1 with Budd-Chiari syndrome [BCS], and 10 supposed epithelioid hemangioendothelioma, 1 with BCS), acute BCS of unknown origin (2 patients), chronic liver failure (4 patients), and solitary hepatocellular cancer (1 patient) were the main indications for LT. Overall survival was 7.2±2.6 months; no patient survived after 23 months. Recurrence was diagnosed after 5.0±2.6 months. Seventeen (77.2%) patients died of tumor recurrence, and the remaining 5 patients died of early infections.


CONCLUSIONS
HAS is an absolute contraindication to LT due to the poor outcome. When dealing with the difficult differential diagnosis between HAS and HE, futile LT can be avoided by taking into consideration their distinct clinical and biochemical behaviors as well as a 6-month wait-list observation period. This time period enables the evaluation of HAS disease progression without compromising prognosis of HE patients, thereby allowing to avoid organ wastage.
Starzl Abdominal Transplant Unit, University Hospitals St. Luc, Brussels, Belgium.
Giuseppe
G
Orlando
Rene
R
Adam
Darius
D
Mirza
Goran
G
Soderdahl
Robert J
RJ
Porte
Andreas
A
Paul
Andrew K
AK
Burroughs
Christian A
CA
Seiler
Michele
M
Colledan
Ivo
I
Graziadei
Juan-Carlos
JC
Garcia Valdecasas
François-René
FR
Pruvot
Vincent
V
Karam
Jan
J
Lerut
D000293:Adolescent; D000328:Adult; D001706:Biopsy; D002648:Child; D002675:Child, Preschool; D005060:Europe; D005260:Female; D006394:Hemangiosarcoma / Q000628:therapy*; D006801:Humans; D007223:Infant; D017093:Liver Failure / Q000401:mortality / Q000628:therapy*; D008113:Liver Neoplasms / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods / Q000592:standards*; D008297:Male; D008875:Middle Aged; D012008:Recurrence; D012042:Registries; D012189:Retrospective Studies; D016896:Treatment Outcome