title: Ten-year experience with liver transplantation for hepatocellular carcinoma in a Federal University Hospital in the Northeast of Brazil.
abstract: Hepatocellular carcinoma (HCC) is the most frequent and important primary liver tumor, with annual worldwide incidence of over 1 million cases, accounting for at least 500,000 deaths per year. The majority of cases of HCC occur in the setting of liver cirrhosis. In this retrospective, descriptive, and analytical study, between May 2002 and April 2012, 664 liver transplantations (LT) were conducted at a Federal University Hospital in the Northeast of Brazil, among which 140 LT were performed in patients with HCC. The tumor was more frequent in men with an average age of 56 years and infected with hepatitis C virus, many with a history of alcohol abuse. Alpha-fetoprotein was not useful in the diagnosis, and imaging methods have failed to diagnose the nodules in 19 patients (13.6%). Transarterial chemoembolization was the most-used bridging therapy to inhibit tumor growth for patients with HCC eligible for transplantation. The implementation of the Model for End Stage Liver Disease score in 2006 brought benefits to these patients. The rate of HCC recurrence after LT was 8.57% and occurred more often in the first 2 years after transplantation, with the liver graft being the most common site. Significant risk factors for recurrence were a long time on the LT waiting list, number of liver nodules over 3.5, and the presence of vascular invasion. In conclusion, LT for HCC leads to excellent long-term survival, with relatively few patients dying from tumor recurrence.
authors.affiliation: Department of Surgery, Federal University of Ceará, Ceará, Brazil. Electronic address: pegcosta@uol.com.br.
authors.forename: P E G
authors.initials: PE
authors.lastname: Costa
authors.affiliation: Department of Surgery, Federal University of Ceará, Ceará, Brazil.
authors.forename: J B M
authors.initials: JB
authors.lastname: Vasconcelos
authors.affiliation: Department of Surgery, Federal University of Ceará, Ceará, Brazil.
authors.forename: G R
authors.initials: GR
authors.lastname: Coelho
authors.affiliation: Department of Surgery, Federal University of Ceará, Ceará, Brazil.
authors.forename: M A P
authors.initials: MA
authors.lastname: Barros
authors.affiliation: Department of Surgery, Federal University of Ceará, Ceará, Brazil.
authors.forename: B A F
authors.initials: BA
authors.lastname: Neto
authors.affiliation: Department of Surgery, Federal University of Ceará, Ceará, Brazil.
authors.forename: D S R
authors.initials: DS
authors.lastname: Pinto
authors.affiliation: Department of Pathology, Federal University of Ceará, Ceará, Brazil.
authors.forename: J T V
authors.initials: JT
authors.lastname: Júnior
authors.affiliation: Department of Community Health, Federal University of Ceará, Ceará, Brazil.
authors.forename: F G S
authors.initials: FG
authors.lastname: Correia
authors.affiliation: Department of Surgery, Federal University of Ceará, Ceará, Brazil.
authors.forename: J H P
authors.initials: JH
authors.lastname: Garcia
mesh_terms: D000328:Adult; D000368:Aged; D001938:Brazil; D006528:Carcinoma, Hepatocellular / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D005260:Female; D006785:Hospitals, University; D006801:Humans; D008113:Liver Neoplasms / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D016031:Liver Transplantation; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000209:etiology / Q000401:mortality; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome