title: Liver transplantation for hepatocellular carcinoma in Ireland: Pre-operative alpha-fetoprotein predicts tumour recurrence in a 14-year single-centre national experience.
abstract: OBJECTIVE
  To examine the results of orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC) in Ireland over a 14-year period.
  
  
  METHODS
  Cases of HCC receiving OLT between January 1995 and September 2009 in the Irish Liver Transplant Unit were reviewed from a prospectively maintained database. Outcome measures included overall and recurrence free survival, alpha-fetoprotein (AFP) and tumour pathological features.
  
  
  RESULTS
  On explant pathology, 57 patients had HCC. The median follow-up time was 42.7 mo. The overall 1, 3 and 5 years survival was 87.7%, 72.1% and 72.4%. There was no difference in survival when compared to patients undergoing OLT without malignancy. The tumour recurrence rate was 14%. The Milan criteria were exceeded in 32% of cases but this did not predict overall survival or recurrence. On multivariate analysis pre-operative AFP > 100 ng/mL was an independent risk factor for recurrence (RR = 5.2, CI: 1.1-24.3, P = 0.036).
  
  
  CONCLUSIONS
  Patients undergoing OLT for HCC had excellent survival even when conventional listing criteria were exceeded. Pre-operative AFP predicts recurrence independent of tumour size and its role in selection criteria should be investigated in larger studies.
authors.affiliation: Donal B O'Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: Donal B
authors.initials: DB
authors.lastname: O'Connor
authors.affiliation: Donal B O'Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: John P
authors.initials: JP
authors.lastname: Burke
authors.affiliation: Donal B O'Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: John
authors.initials: J
authors.lastname: Hegarty
authors.affiliation: Donal B O'Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: Aiden P
authors.initials: AP
authors.lastname: McCormick
authors.affiliation: Donal B O'Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: Niamh
authors.initials: N
authors.lastname: Nolan
authors.affiliation: Donal B O'Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: Emir
authors.initials: E
authors.lastname: Hoti
authors.affiliation: Donal B O'Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: Donal
authors.initials: D
authors.lastname: Maguire
authors.affiliation: Donal B O'Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: Justin
authors.initials: J
authors.lastname: Geoghegan
authors.affiliation: Donal B O'Connor, Department of Surgery, Trinity Centre for Health Sciences, Tallaght Hospital, Dublin 24, Ireland.
authors.forename: Oscar
authors.initials: O
authors.lastname: Traynor
keywords: Alpha-fetoprotein; Hepatocellular carcinoma; Liver cirrhosis; Liver transplantation; Transplantation selection criteria