Factors affecting recurrence and survival after living donor liver transplantation for hepatocellular carcinoma.
OBJECTIVE
HCC is a leading cause of cancer-related deaths worldwide. The main etiological factor in Egypt is HCV infection. Lack of cadaveric transplantation in Egypt makes LDLT the only available option for liver transplantation for HCC patients with advanced cirrhosis and/or non-resectable tumors.


METHODS
Between January 2004 and April 2012, 170 patients underwent LDLT at the Liver Transplantation Unit, Mansoura University, and 52 (30.6%) were shown to have HCC by pathological examination. Patient demographics, preoperative interventions and pathological findings were evaluated for their influence on recurrence and survival. Patients were followed-up with abdominal sonography and AFP every 3 months and CT scans every 6 months. Median follow-up was 22.9 months.


RESULTS
The main cause of underlying cirrhosis was HCV (96.2%). One or more different pre-transplant treatments of HCC were performed in 14 (27.4%) patients. The median total size was 4cm (0.8-15.5). Microvascular invasion was detected in 16 (31.4%) patients; 16 patients proved to have tumors beyond the Milan criteria. Pre-transplantation AFP more than 200ng/mL, total tumor size more than 8cm and microvascular invasion influenced recurrence rate on univariate analysis. Multivariate analysis identified AFP (p = 0.016) as independent factor for recurrence. Survival was significantly affected by AFP (p = 0.003) and microvascular invasion (p = 0.003).


CONCLUSIONS
LDLT is a feasible option for patients with HCC on top of cirrhosis with good survival and recurrence-free survival rates.
Mohammed
M
Abdel-Wahab
Ahmad M
AM
Sultan
Omar M
OM
Fathy
Tarek
T
Salah
Mohammed M
MM
Elshobary
Nabieh A
NA
Elghawalby
Amr M
AM
Yassen
Walid M R
WM
Elsarraf
Mohammed F
MF
Elsaadany
Khaled
K
Zalatah
D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016009:Chi-Square Distribution; D018572:Disease-Free Survival; D004534:Egypt; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008113:Liver Neoplasms / Q000097:blood / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects* / Q000401:mortality; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D018579:Patient Selection; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D000509:alpha-Fetoproteins / Q000378:metabolism
C097353:AFP protein, human; D000509:alpha-Fetoproteins