Tumor number, size, and macrovascular invasion are the most widely used predictors of survival after liver transplantation for hepatocellular carcinoma.
Dr Shimul Shah and colleagues analyzed all patients undergoing liver transplantation for hepatocellular carcinoma at their center.
The research team established the accuracy of preoperative clinical staging, and determined which patients had a higher probability of being understaged.
The team identified 118 patients with confirmed hepatocellular carcinoma after liver transplantation from 1991 to 2004.
All patients were monitored with serial imaging every 3 months to ensure their eligibility for liver transplantation within Milan criteria.
Understaging in the 118 patients was defined as evidence on explant pathology that Milan criteria had been exceeded.
|The recurrence rate was 15% at 30 months after transplant|
The researchers observed that the 5-year disease free survival was 78%.
The recurrence rate was 15% after a median follow-up after liver transplantation of 30 months.
On explant pathology, 43% of patients exceeded Milan criteria and had a worse disease free survival rate compared to those who met liver transplantation criteria.
The team noted that understaging was more likely in patients with imaging characteristics of 2 tumor nodules or more.
Tumor growth of 0.25 cm/month or more, and pathologic findings of vascular invasion, and bilobar tumors also lead to understaging.
Dr Shah's team concluded, “Preoperative imaging every 3 months while on the waiting list frequently understages hepatocellular carcinoma as assessed by explant pathology.”
“Recurrence after liver transplantation often occurred in patients that were understaged.”
“Improving the accuracy of clinical staging and inclusion parameters will ensure proper organ allocation and acceptable outcomes after liver transplantation.”