Liver transplantation and HCC: the importance of an individualized approach in BCLC D patients

Abstract

Introduction: Hepatocellular carcinoma (HCC) is an aggressive tumor with raising incidence worldwide. Liver transplant (LT) is the only therapeutic option with potential to simultaneously cure HCC and subjacent chronic liver disease. For patients with end-stage disease BCLC D palliative treatment is the only indicated, with survival less than 3 months. Method: From January 2010 to December 2015, 333 LT were performed, 81 for HCC (58.7 ± 6.7 years), predominantly male patients (85%). Median of MELD was 13 and 52% Child-Pugh B/C. The BCLC classification was 8.8% in very early stage (0), 45% in early stage (A), 31.2% in intermediate stage (B), 0% in advanced stage (C) and 15% in end-stage disease (D). Study of prognostic factors of overall survival (OS) and disease free-survival (DFS). Univariate and multivariate analysis (p < 0.05). Results: At 90 days mortality rate was 4.9% and major morbidity 37%. After median follow-up of 23 ± 22 months, OS was 68 ± 3 months (5-yr OS 83.2%), and DFS was 60 ± 4 months (5yr DFS 76.8%). Differences in survivals between BCLC stages were not observed. At 5 years, OS was 83.3% vs. 85.6% (p = 0.717) and DFS was 83.3% vs. 83.7% (p = 0.794) for patients BCLC D patients vs other stages (0, A, B, C) respectively. Conclusions: LT is a good therapeutic option for HCC with acceptable morbidity and mortality. A good selection of patients with an initial indication for palliative treatment (BCLC D) can allow similar outcomes to those with formal indication for LT, increasing significantly survival and quality of life.