MODERATELY OR WELL-DIFFERENTIATED HEPATOCELLULAR-CARCINOMA AND LIVER TRANSPLANTATION

Abstract

P597 Aims: In this study To determine the long-term results of liver transplantation for well- or moderately-differentiated hepatocellular carcinoma (HCC). HCC patient selection for liver transplantation remains controversial and deciding exclusively on the strength of criteria such as number and size of nodules appears prognostically inaccurate. Methods: Since 1991, pre-operative tumor grading has been used at our center to establish whether a patient with HCC is fit for transplantation. Poorly-differentiated HCC cases are excluded, while size and number of nodules are not considered as absolute selection criteria. Thirty-three patients with moderately- or well-differentiated HCC were prospectively studied after liver transplantation and compared with a group of 15 patients with incidental HCC transplanted during the same period. Results: On histological examination, 38% of the entire group of 48 patients did not meet the “Milan criteria” and 42% were pTNM stages III and IV. The median follow-up was 44 months. The 5-year actuarial survival rate was 75% and recurrence-free survival was 92%. HCC recurred in only 3 patients (6%). The only histo-morphological variable differing significantly between incidental and non-incidental HCC was nodule size. Timing of diagnosis (incidental vs. non-incidental HCC), Milan criteria and TNM stage revealed no statistically significant impact on overall and recurrence-free survival rates. Conclusions: Routine pre-OLT tumor grading may be a valid tool in the selection of unresectable HCC patients for transplantation.