Treatment and outcome of hepatocellular carcinoma in renal transplant patients

Abstract

4212 Background: Hepatocellular carcinoma (HCC) is a complication of chronic liver diseases and the incidence in the renal transplant (RT) population is higher than in the general population (1.4–4% vs. 0.01–0.05%). The natural history and outcome of treatment of HCC in this population are unknown. Methods: We retrospectively evaluated the incidence, the treatments performed and the outcome of HCC in the population transplanted in our center between January 1980 and December 1998 and followed up to August 2003. Results: During the study period 534 renal transplants were performed. We found 6 HCC (incidence 1.12% of the entire population and 2.29% of patients with chronic viral hepatitis), 5 were men, and all had chronic viral hepatitis: 3 HBV, 1 HCV and 2 had an HBV/HCV coinfection. HCC was diagnosed 124.1 (range, 45 to 244) months after transplantation. All patients presented abnormal liver function tests and tumors larger than 5 cm. Four had more than 3 tumors and 3 had an alpha-fetoprotein level higher than 400 IU/ml. Three patients received no treatment (CLIP score 5, 6 and 4; survival 1, 1 and 4 months respectively); in 2 patients chemoembolization was performed (CLIP score 3 and 2; survival 6 and 12 months respectively) and 1 received ethanol injections (CLIP score 2, survival 4 months). The overall survival was 4.5 months. Conclusions: HCC in RT patients is a common complication: the CLIP score adequately predicted prognosis; the outcome was poor, because HCC was detected in an advanced stage. Screening strategies for early diagnosis should be evaluated as different treatment modalities. No significant financial relationships to disclose.