title: Predictors of tumor-free survival after liver transplant in patient with hepatocellular carcinoma.
abstract: OBJECTIVE
  To identify the predictors of overall survival and tumor-free survival of 88 hepatocellular carcinoma patients who were treated with orthotopic liver transplant at Shiraz Organ Transplant Center.
  
  
  METHODS
  We performed this retrospective study after reviewing the transplant database of all patients who underwent orthotopic liver transplant secondary to hepatocellular carcinoma and liver cirrhosis. Hepatocellular carcinoma was diagnosed in 70 patients before liver transplant and 18 patients on histologic examination of the explanted livers. Cox regression identified independent factors that affected posttransplant survival.
  
  
  RESULTS
  The overall survival rate was 83% and the tumor-free survival rate was 79.5%. Independent factors for tumor recurrence were Milan criteria, alpha-fetoprotein level before operation ≥ 400 ng/mL, tumor grade, vascular invasion, and age. Vascular invasion (odds ratio, 5; 95% confidence interval, 1.1 to 25.496; P = .049) and tumor grade (odds ratio, 14.42; 95% confidence interval, 3.652 to 56.95; P < .001 were statistically significant.
  
  
  CONCLUSIONS
  Vascular invasion and tumor grade were predictive factors for tumor-free survival.
authors.affiliation: From the Shiraz Organ Transplant Center, Shiraz, Iran.
authors.forename: Alireza
authors.initials: A
authors.lastname: Shamsaeefar
authors.forename: Saman
authors.initials: S
authors.lastname: Nikeghbalian
authors.forename: Kourosh
authors.initials: K
authors.lastname: Kazemi
authors.forename: Siavash
authors.initials: S
authors.lastname: Gholami
authors.forename: Nasrin
authors.initials: N
authors.lastname: Motazedian
authors.forename: Nadia
authors.initials: N
authors.lastname: Motazedian
authors.forename: Mohammad Ebrahim
authors.initials: ME
authors.lastname: Fallahzadeh
authors.forename: Maryam
authors.initials: M
authors.lastname: Moini
authors.forename: Bita
authors.initials: B
authors.lastname: Gramizadeh
authors.forename: Seyed Ali
authors.initials: SA
authors.lastname: Malekhosseini
mesh_terms: D000328:Adult; D006528:Carcinoma, Hepatocellular / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007492:Iran; D008113:Liver Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D016017:Odds Ratio; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome