EFFICACY OF LIVER TRANSPLANTATION IN THE TREATMENT OF MALIGNANT LIVER DISEASES - A SINGLE CENTER EXPIRIENCE

Abstract

753 Liver transplantation (OLT) is the only curative therapeutic option for patients with malignant liver diseases. Early reports showed that the efficacy of OLT is limited by high tumor-recurrence rates. Recent studies, however, demonstrated that outcome is highly dependent on tumor stage and patients with early stages have survival rates comparable to those of patients transplanted for benign liver diseases. In this retrospective study we analyzed data of patients who were transplanted for malignant liver diseases at our center. Between 4/85 and 3/97 70 out of 292 patients (24%) with malignant liver diseases underwent OLT. In 54 patients a hepatocellular carcinoma (HCC) was diagnosed, 9 patients had a cholangiocarcinoma (CCa) and 7 patients a metastatic liver disease of a neuroendocrine tumor. Mean follow-up of all patients was 23 months. The actuarial patient survival of all patients at 1, 3, 5, and 10-years were 72.9%, 53.9%, 32.2% and 19.3%, respectively. These rates are significantly reduced compared to those of patients transplanted for benign liver diseases. The main causes of death were tumor recurrence (n=19) and infection-related (n=8). In 4 patients reOLT was necessary. No difference in overall outcome was seen between patients transplanted for HCC, CCa and neuroendocrine tumor. Regarding patients with HCC survival was significantly dependent on tumor stage. Patients with stage I/II (n=12) and stage III (n=17) tumors, according to UICC criteria, had 1, 3 and 5-year survival rates of 90.9%, 78.8%, 78.8% and 93.3%, 67.9% and 60.5%, respectively. These rates did not differ significantly from those of benign liver diseases (p>0.05). Chemoembolisation (TACE) was applied to 24 patients prior to OLT. TACE showed a slight positive effect on overall survival, but this difference did not reach statistical significance. No difference was found concerning the etiology of liver disease. The median survival of patients with CCa was 1.9 years. Most of these patients died due to tumor-recurrence. Although all patients with neuroendocrine tumor and liver metastases developed tumor recurrence, the median survival was 2.6 years. Our data showed that OLT is effective in the treatment of malignant liver diseases. Especially patients with low stage HCCs demonstrated survival rates equal to those of patients with benign liver cirrhosis which is consistent with previous reports (Hepatology 1997)