Abstract
Purpose We aimed to identify prognostic factors for survival and recurrence of hepatocellular carcinoma (HCC) after liver transplantation (LT) for patients with HCC and hepatitis C virus-related cirrhosis (HCV-cirrhosis). Methods This retrospective cohort study followed all adult patients with HCV-cirrhosis who underwent LT because of HCC or had incidental HCC identified through pathologic examination of the explanted liver at a university hospital in Rio de Janeiro, Brazil, over 11 years (1998-2008). We used Cox regression models to assess the following risk factors regarding HCC recurrence or death after LT: age, Model for End-stage Liver Disease score, Child-Pugh classification, alpha-fetoprotein (AFP), whether patients had undergone locoregional treatment before transplantation, the number of packed red blood cell units (PRBCU) transfused during surgery, the number and size of HCC lesions in the explanted liver, and the presence of microvascular invasion and necrotic areas within HCC lesions. Results Seventy-six patients were followed up for a median (interquartile range (IQR)) of 4.4 (0.7-6.6) years. Thirteen (17%) patients had HCC recurrence during the follow-up period, and 26 (34%) died. The median survival time was 6.6 years (95% CI: 2.4-12.0), and the 5-year survival was 52.5% (95% CI: 42.3-65.0%). The final regression model for overall survival included four variables: age (hazard ratio (HR): 1.02, 95% CI: 0.96-1.08, P = 0.603), transplantation waiting time (HR: 1.00, 95% CI: 1.00-1.00, P = 0.190), preoperative AFP serum levels (HR: 1.01, 95% CI: 1.00-1.02, P = 0.006), and whether >4 PRBCU were transfused during surgery (HR: 1.15, 95% CI: 1.05-1.25, P = 0.001). The final cause-specific Cox regression model for HCC recurrence included only microvascular invasion (HR: 14.86, 95% CI: 4.47-49.39, P < 0.001). Conclusion In this study of LT for HCV-cirrhosis, preoperative AFP levels and the number of PRBCU transfused during surgery were associated with overall survival, whereas microvascular invasion with HCC recurrence.
Highlights
Hepatocellular carcinoma (HCC) represents the third cancer-related cause of death in the world and has an estimated incidence of roughly 750,000 new cases each year [1, 2]
23 patients undergoing Liver transplantation (LT) due to hepatitis C virus (HCV)-cirrhosis had their explanted livers diagnosed with incidental HCC
The outcomes after LT for patients with liver cirrhosis and HCV depend on variables related to the transplantation, such as organ availability, donor selection, allocation strategies, liver disease severity, and local expertise and on factors associated with HCC survival, such as AFP levels and tumor characteristics
Summary
Hepatocellular carcinoma (HCC) represents the third cancer-related cause of death in the world and has an estimated incidence of roughly 750,000 new cases each year [1, 2] It is associated with high recurrence rates of up to 80% after surgical resection and with lower survival rates when compared with other cancers. In a landmark article published in 1996, the adoption of the Milan criteria for the selection of adult patients with HCC for LT was associated with an improvement in overall survival rates from about 35% in five years to 75% in four years and recurrence rates below 10% [5]. These criteria involve only the following: single tumor ≤ 5 cm, or up to 3 foci of the tumor, each ≤ 3 cm, and no evidence of gross vascular invasion or extrahepatic metastasis [6]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
