title: Incidence, Characteristics, and Prognosis of Incidentally Discovered Hepatocellular Carcinoma after Liver Transplantation.
abstract: Background. We aimed to assess incidentally discovered hepatocellular carcinoma (iHCC) over time and to compare outcome to preoperatively diagnosed hepatocellular carcinoma (pdHCC) and nontumor liver transplants. Methods. We studied adults transplanted with a follow-up of at least one year. Patients were divided into 3 groups according to diagnosis of hepatocellular carcinoma. Results. Between 1990 and 2010, 887 adults were transplanted. Among them, 121 patients (13.6%) had pdHCC and 32 patients (3.6%) had iHCC; frequency of iHCC decreased markedly over years, in parallel with significant increase in pdHCC. Between 1990 and 1995, 120 patients had liver transplants, 4 (3.3%) of them had iHCC, and only 3 (2.5%) had pdHCC, while in the last 5 years, 263 patients were transplanted, 7 (0.03%) of them had iHCC, and 66 (25.1%) had pdHCC (P < 0.001). There was no significant difference between groups regarding patient survival; 5-year survival was 74%, 75.5%, and 77.3% in iHCC, pdHCC, and non-HCC groups, respectively (P = 0.702). Patients with iHCC had no recurrences after transplant, while pdHCC patients experienced 17 recurrences (15.3%) (P = 0.016). Conclusions. iHCC has significantly decreased despite steady increase in number of transplants for hepatocellular carcinoma. Patients with iHCC had excellent outcomes with no tumor recurrence and survival comparable to pdHCC.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada T6G 2B7; Department of Surgery, Sohag University, Sohag 82524, Egypt.
authors.forename: Walid
authors.initials: W
authors.lastname: El Moghazy
authors.affiliation: Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada T6G 2B7; Department of Surgery, National Liver Institute, Menoufia University, Menoufia 32721, Egypt.
authors.forename: Samy
authors.initials: S
authors.lastname: Kashkoush
authors.affiliation: Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada T6G 2B7.
authors.forename: Glenda
authors.initials: G
authors.lastname: Meeberg
authors.affiliation: Division of Transplantation, Department of Surgery, University of Alberta, Edmonton, AB, Canada T6G 2B7.
authors.forename: Norman
authors.initials: N
authors.lastname: Kneteman