title: Long-term survival outcomes for living donor liver transplant recipients with pathologically nonviable hepatocellular carcinoma.
abstract: OBJECTIVE
  Complete necrosis of hepatocellular carcinoma (HCC) lesions has occasionally been found by explant pathology after pretransplant neoadjuvant treatment. This study sought to investigate the long-term prognostic effect of loss of tumor viability after HCC treatment in living donor liver transplant (LDLT) recipients.
  
  
  METHODS
  We reviewed retrospectively the 5-year records of 37 patients who demonstrated nonviable HCC on explant pathology.
  
  
  RESULTS
  The most common primary disease was hepatitis-B-virus-associated liver cirrhosis (n = 34). Single explant tumors were found in 29 patients; the mean maximal tumor size was 2.1 ± 0.9 cm (range: 0.8-4.0). No patients showed microvascular invasion. The median level of alpha-fetoprotein was 12 ng/mL (range: 1-1160). The 1 patient who showed a recurrence at 20 months remains alive more than 6 years after adrenalectomy and repeated pulmonary metastasectomy. The 5-year HCC recurrence rate was thus 2.1%. There were 2 late mortalities, each due to graft failure and recurrent gastric cancer. The overall patient survival rate was 97.3% at 5 and 92.7% at 10 years.
  
  
  CONCLUSIONS
  The results of this study revealed that the loss of tumor viability induced by pretransplant neoadjuvant treatment definitely decreased the risk of post-transplant HCC recurrence. Therefore, patients with nonviable HCC can be regarded as members of a superselect group with minimal risk for HCC recurrence, and may be exempted from routine HCC screening.
authors.affiliation: Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.
authors.forename: H-W
authors.initials: HW
authors.lastname: Park
authors.forename: S
authors.initials: S
authors.lastname: Hwang
authors.forename: C-S
authors.initials: CS
authors.lastname: Ahn
authors.forename: K-H
authors.initials: KH
authors.lastname: Kim
authors.forename: D-B
authors.initials: DB
authors.lastname: Moon
authors.forename: T-Y
authors.initials: TY
authors.lastname: Ha
authors.forename: G-W
authors.initials: GW
authors.lastname: Song
authors.forename: D-H
authors.initials: DH
authors.lastname: Jung
authors.forename: G-C
authors.initials: GC
authors.lastname: Park
authors.forename: J-M
authors.initials: JM
authors.lastname: Namgoong
authors.forename: C-S
authors.initials: CS
authors.lastname: Park
authors.forename: Y-H
authors.initials: YH
authors.lastname: Park
authors.forename: S-H
authors.initials: SH
authors.lastname: Kang
authors.forename: B-H
authors.initials: BH
authors.lastname: Jung
authors.forename: S-G
authors.initials: SG
authors.lastname: Lee
mesh_terms: D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D016031:Liver Transplantation; D019520:Living Donors; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome