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 27 May 2018

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News

Can hepatocellular carcinoma be considered an indication for liver transplantation?

Recurrent tumor and HCV-related recurrent diseases significantly hamper the outcome of liver transplanted patients with hepatocellular carcinoma, find researchers in the latest issue of Liver Transplantation.

News image

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Hepatocellular carcinoma (HCC) is considered a controversial indication for liver transplantation (LT), mainly due to of long waiting times and underlying viral cirrhosis.

In this study, researchers from Spain evaluated the outcome of LT in 104 patients with HCC and cirrhosis (mainly hepatitis C virus (HCV)-related) in a center with a short waiting time (median, 105 days).

The research team divided patients into 4 groups: HCV positive with HCC (group 1, n = 81), HCV negative with HCC (group 2, n = 23), HCV positive without HCC (group 3, n = 200), and HCV negative without HCC (group 4, n = 207).

Predictors of tumor recurrence were demographics, tumor related factors, donor and surgery related factors, and year of transplantation. The team used these variables and tumor recurrence data to evaluate effects on survival.

Patients were followed up for a median of 29 months.

Survival significantly lower in patients with HCC than in those without.
Liver Transplantation
The team found patient survival at 1 year to be 70%, 87%, 81%, and 88% of groups 1, 2, 3, and 4, respectively.

In addition, survival at 5 years was 59%, 77%, 64%, and 77% for groups 1 to 4, respectively.

They found that survival was significantly lower in patients with HCC than in those without (74% and 63% versus 85% and 70%, at 1 and 5 years, respectively).

The causes of death in those with HCC were tumor recurrence (24%) and recurrent HCV (8%), versus sepsis (34%) and recurrent HCV (14%) in those without HCC.

They also found that HCC recurrence occurred in 12 patients (12%) at a median of 14 months, with a probability increasing from 8% at 1 year to 16% at 5 years.

Furthermore, in patients with HCC, tumor recurrence was associated with vascular invasion.

In multivariate analysis, variables predictive of survival were donor old age, viral-related etiology, and tumor recurrence.

Dr Angel Moya's team concluded, "Although HCC still remains an adequate indication for LT in centers with high prevalence of HCV infection and short waiting times, both tumor and HCV-related recurrent diseases hamper significantly the outcomes of these patients".

Liver Transpl 2002; 8: 1020-7
14 November 2002

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