title: Tumor Characteristics and Long-Term Outcome of Incidental Hepatocellular Carcinoma After Orthotopic Liver Transplant.
abstract: OBJECTIVE
  Orthotopic liver transplant is the treatment of choice for hepatocellular carcinoma in cirrhotic patients with satisfactory oncologic and survival outcomes. Incidental hepatocellular carcinoma is frequently a reported finding in the explant pathology after orthotopic liver transplant.
  
  
  METHODS
  The present study retrospectively analyzed the tumor characteristics and outcomes of 50 incidental hepatocellular carcinomas compared with 252 transplants for known hepatocellular carcinoma.
  
  
  RESULTS
  Patients with incidental hepatocellular carcinoma had lower peak alpha-fetoprotein level (P = .001), lower pretransplant alpha-fetoprotein level (P = .002), smaller total tumor size (P = .0001), fewer tumor numbers (P = .0001), lower level of microvascular invasion (P = .001), more cases within Milan criteria (P = .005), and more well-differentiated tumors (P = .017). However, no difference in survival rates was observed between the 2 groups. In 35 patients (70%) who had incidental hepatocellular carcinoma, pretransplant imaging studies were normal; ultrasonography was used as the only screening tool in 25 of 35 patients (71%) who had incidental hepatocellular carcinoma, and 15 patients (30%) who had incidental hepatocellular carcinoma had regenerative or dysplastic nodules. The accuracy of ultrasonography in our unit for diagnosing hepatocellular carcinoma was 97.5%. A quarter of hepatitis B recipients had incidental hepatocellular carcinoma with a younger median recipient age. Tumor recurrence was higher with incidental hepatocellular carcinoma in hepatitis C recipients (22%). However, the overall recurrence was similar between all hepatitis and nonhepatitis recipients who were transplanted for incidental or known hepatocellular carcinoma.
  
  
  CONCLUSIONS
  Incidental hepatocellular carcinoma has similar outcome as known hepatocellular carcinoma. Early screening of hepatitis B patients is recommended, and cross-sectional imaging is not mandatory for hepatocellular carcinoma screening in patients who are on the waiting list.
authors: Liver Unit, Queen Elizabeth Hospital, Birmingham, United Kingdom.
authors: Moustafa Mabrouk
authors: MM
authors: Mourad
authors: Abdullah
authors: A
authors: Algarni
authors: Menna-Allah
authors: MA
authors: Aly
authors: Bridget K
authors: BK
authors: Gunson
authors: Hynek
authors: H
authors: Mergental
authors: John
authors: J
authors: Isaac
authors: Paolo
authors: P
authors: Muiesan
authors: Darius
authors: D
authors: Mirza
authors: M Thamara P R
authors: MT
authors: Perera
authors: Simon R
authors: SR
authors: Bramhall
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D002454:Cell Differentiation; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D033162:Incidental Findings; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008113:Liver Neoplasms / Q000097:blood / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016031:Liver Transplantation / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014850:Waiting Lists; D055815:Young Adult; D000509:alpha-Fetoproteins / Q000032:analysis
chemical_list: C097353:AFP protein, human; D000509:alpha-Fetoproteins